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Class ^BS*AJa. 
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Copyright N° 

COPYRIGHT DEPOSIT. 



The 
Practice of Medicine 



BY 

A. M. NICKS, M. D., 

Author of the Practice of Medicine in Plain English, etc., etc. 

and 

A. T. CHATHAM, M. D. 



If I 






CHATHAM & NICKS, PUBLISHERS 

CLARKTON, MISSOURI 

1906 



-IP 



Co 



\V<*- 



LIBRARY of CONGRESS 

Two Copies Received 

APR 8 isor 

GLASS "fl XXc.No. 
COPY B. / 



Copyrighted 1906 

BY 

CHATHAM & NICKS 



Preface 

The Authors have, each, practiced medicine more than 
an average professional life-time and have carefully studied 
the needs of families, and have used every effort to supply 
the public with a plain, reliable Practice of Medicine. 

In a great majority of cases, the treatment recommended 
is that which the Authors, from experience, have found 
most beneficial. 

The doses recommended in the body of the work, when 
not expressly stated otherwise, are for adults. (See Table 
of Doses, Part X.) 

We acknowledge our indebtedness to J. W. Carr, A. M., 
Ph. D., of the Modern Language Department of the Uni- 
versity of Arkansas for having carefully read our manu- 
script. 

Without further comment the work is submitted to the 
public hoping that it will be the means of accomplishing 
much good. 
September, 1906. The Authors. 



THE PRACTICE OF MEDICINE 

PART ONE. 



THE 
PRACTICE OF MEDICINE 

PART I. 
INTRODUCTION. 

Disease is any variation from the standard of healthy 
function or structure. 

Organic diseases are those that are associated with an 
organic change in the affected part. 

Functional diseases are those in which there is no 
apparent structural change in the part. 

A contagious disease is one whose causative agent is 
a specific poison that is capable of being communicated 
from the sick to the well by personal contact or close 
proximity. 

An infectious disease is also due to a special cause 
that under certain conditions is capable of unlimited 
increase or multiplication. An infectious disease may or 
may not be contagious. 

An abrupt termination of disease is called a crisis. 

Lysis is a gradual return to health. 

Pathology is that branch of medicine, which treats 
of the nature, causes, symptoms and results of disease. 



8 THE PRACTICE OF MEDICINE. 

The suffix itis added to the anatomical name of the 
part affected always denotes an inflammation, as tonsillitis, 
gastritis, enteritis, etc. 

THE HYPODERMIC SYRINGE. 

The advantages of the hypodermic syringe are, when 
patients are suffering with hemorrhage, severe pain, etc., 
the effects of medicines may be obtained in ten or fifteen 
minutes, which is a much shorter time than when med- 
icines are given by the mouth; and, then, where the 
stomach is so irritable that nothing can be retained by 
it, remedies may be introduced into the system by this 
method. 

See that your hypodermic syringe is kept scrupulously 
clean; keep a small wire in the needle when it is not in use; 
use clear, clean water, preferably that which has been 
recently boiled; and after the syringe has been filled with 
the solution to be used hold it in a vertical position, the 
needle upwards, and press the plunger slowly upward 
until all air is expelled from the instrument, which may 
be known by the liquid's escaping from the needle drop 
by drop; then, pinch up the skin, between the thumb 
and index finger, above the elbow on the back part of 
the arm, and insert the needle through the skin and slowly 
press the plunger until the syringe is emptied. Avoid 
puncturing a vein or an artery; and do not use any remedy, 
hypodermically, unless this, or some other standard 
work recommends its use by this method, as many agents, 
when used with the needle, produce violent sores. 



THE PULSE. 9 

Before undertaking to use the hypodermic syringe 
it would probably be advisable to get your family physician 
to instruct you in its use. Should he refuse to do so, he 
is too small to render you good service and we advise 
you to employ a broader-minded man. 
TEMPERATURE. 
The temperature of the human body, when in health 
is 98 2-5 degrees (Fahr.). Where the temperature is above 
this, the patient has fever; and where it is under this it 
is too low and stimulants should be given. 

Each family should have a reliable fever-thermometer. 
Any physician or druggist will take pleasure in instructing 
you in its proper use. 

THE PULSE. 
The pulse of an adult male in health is about 70 per 
minute, while that of a female is about 80. 

A good rule would be to count the pulse in each of 
the family, while in health, and keep a record of the same 
for future use. 

The following, it is thought, will give the reader a very 
good idea of the pulse-rate from infancy to old age: 

At birth, 130 to 140. 

One month, 125 to 135, 

One year, 115 to 130. 

Two years, 100 to 115, 

Three years, 95 to 100. 

Seven years, 90 to 95. 

Fourteen to eighteen, 80 to 90, 

Adult male, 70 to 75. 



io THE PRACTICE OF MEDICINE. 

Adult female, 75 to 80. 

Old age, 60 to 70. 

One degree of fever usually increases the pulse ten 
beats per minute, two degrees twenty and so on. 

Suppose you know that the pulse of your sick 
child, when in health, is 90 and you examine and find 
that it is 100, what would be your conclusion? That the 
child had one degree of fever. Certainly. What if you 
were to examine the child again and find that its pulse 
is no per minute? You would conclude that it had two 
degrees of fever and your conclusion would usually be 
correct; however, we have no way of definitely determining 
the temperature except by the use of a thermometer, as, 
occasionally, we find a high fever without any increase in 
the pulse-rate. 

Weakness, as well as excitement, quickens the pulse. 

After the loss of considerable blood, and after exhausting 
sickness the pulse becomes very small and rapid. This, 
in such cases, is caused by weakness; and it is hoped that 
the reader will learn to distinguish a rapid, full pulse 
caused by fever from a rapid, feeble pulse, caused by 
weakness. 

FEVER REMEDIES. 

Remedies to control fever are selected by the condition 
of the pulse, therefore, a remedy that is used in one fever 
may be used, the pulse being similar, in all other fevers. 
A fever resulting from an inflammation, such as pneu- 
monia, tonsillitis, dysentery, enteritis, nephritis, etc., is 
controlled exactly as we would a fever resulting from 



FEVER REMEDIES. n 

malaria, smallpox, measles, whooping-cough or other 
causes. 

In all fevers where the pulse is too quick, too full, and 
too strong, give Tr. of Veratrum Viride or Tr. of Aconite 
Root. 

In all stomach and bowel troubles, and in diseases of 
children, where there is fever, Aconite should be used. 
In all other conditions Veratrum is the better remedy. 
Prepare them for use as follows: 

Tr. of Veratrum Viride, 18 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful of the mixture every one 
or two hours while there is fever, or: 

Tr. of Aconite Root, 18 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful of the mixture every one or 
two hours. 

In addition to the foregoing where the fever is high from 

3 to 5 grains of Acetanilide may be given every three hours. 

In all fevers where the heart's action (pulse) is weak 

or irregular give Digitalis, or Digitalis and Cactus, thus: 

Fl. Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grand., 24 drops, 

Water, 12 teaspoonfuls. 

Mix and give a teaspoonful of the mixture every two 
hours while the pulse is weak or irregular. 

Remember that Aconite, Veratrum, and Acetanilide 
are heart depressants — they weaken the pulse; and it is 
proper to use one or all of them, in all fevers where the 



12 THE PRACTICE OF MEDICINE. 

heart's action is too strong. Aconite has a tendency to 
quiet a sick stomach while Veratrum has a tendency to 
irritate it. 

Do not use a sufficient amount of Acetanilide to cause 
profuse or continuous perspiration, as this is exhausting 
and is injurious. 

Digitalis and Cactus are heart stimulants, and should 
be used in all fevers, or other troubles, where the heart's 
action is too weak. 

In all fevers be sure to keep the head cool and the 
feet warm. 

CONGESTION OF THE BRAIN. 

There are two forms of congestion of the brain; the 
active and the passive. 

All persons when they have fever are liable to have one 
or the other. Adults usually have the active, and children 
the passive; though, an adult may have the passive and a 
child may have the active. 

The active congestion is a determination of blood to 
the brain — the brain is over-stimulated. In these cases, 
the patient is restless, the head hot, the face flushed and 
the pupils contracted or too small. 

Wherever you see these symptoms, examine the pulse 
and if it is quick and full give one drop of the Tr. of Vera- 
trum Viride and one and one-half drops of the Fluid 
Extract of Gelsemium every hour and a half, thus: 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, 18 teaspoonfuls. 



CONGESTION OF THE BRAIN. 13 

Mix and give a teaspoonful at a dose. 
If the stomach is irritated, give Aconite instead of the 
Veratrum, as follows : 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, r 18 teaspoonfuls. 

Mix and give a teaspoonful of the mixture every hour 
and a half while there is fever. 

Bromide of Potash is very useful in these cases. It 
may be added when used to the preparation of Veratrum 
and Gelsemium, thus: 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Bromide of Potash, 3 drachms, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half 
while there is fever. If the Gelsemium is used the Potash 
will rarely ever be needed, as the former is almost a specific 
in these cases. 

In addition to the foregoing, if the fever is high, give 
from 3 to 5 grains of Acetanilide every two or three 
hours. 

The passive congestion is a sluggishness of the hair-like 
blood vessels of the brain, with consequent venous fullness. 
There is not too much blood thrown to the brain, but it 
fails to get away from the brain as rapidly as it should. 
Blood which leaves the heart passes out through arteries 
and from the arteries through capillaries (hair-like blood 
vessels) into the veins and through the veins to the heart. 



•14 THE PRACTICE OF MEDICINE. 

In the passive congestion the patient sleeps more than 
is natural, sleeps with the eyes partly open, often jerks or 
jumps in his sleep as if frightened; and the head is hot 
and the feet and hands are cool or cold. Belladonna is 
the remedy in this case. Examine the pulse, and if it is 
quick and strong give one drop of the Tr. of Aconite with 
one-third of a drop of the Fluid Extract of Bella- 
donna, as : 

Tr. Aconite Root, 18 drops, 

Fl. Ext. Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful of the mixture every hour 
and a half while there is fever. 

If the pulse is weak or irregular give Digitalis and 
Cactus instead of the Aconite, adding the Belladonna, 
thus : 

Fl. Ext. of Digitalis, 18 drops, 

Fl. Ext. of Cactus Grandiflorus, . . . 36 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful of the mixture every two 
hours. 

Above all things keep the head cool and the feet warm 
in both of the foregoing conditions. If you use wet cloths, 
change them frequently. Do not allow them to become 
warm on the head. If necessary, in order to keep the 
head cool, pour cold water on it, as often as is necessary 
to accomplish the desired results, or use an ice bag for 
a pillow. 



THE TONGUE. 15 

If the feet are cold bathe them in warm water and, 
then, wrap them up well with a blanket and apply hot 
irons, or other articles that will retain heat, to them, being 
careful, however, not to burn them. 

Do not use Bromide of Potash or Gelsemium in passive 
congestion of the brain, as they are contra-indicated in this 
condition and are dangerous. 

Do not use Belladonna in fevers unless the pupils 
(sight) are too large. 

Never, under any circumstances, give Acetanilide or 
any form of Opium in passive congestion of the brain. 

THE TONGUE. 

A pale tongue, uniformly coated with a filthy, whitish 
coat shows that there is too much acid in the system and 
the condition demands a salt of soda. Sulphite of Soda 
is the remedy in this case. It may be given in 20-grain 
doses every three or four hours until the tongue becomes 
clean and normal in color. 

Where the tongue and mucous membrane are too red, 
or red and dry, give Hydrochloric Acid. Two or three 
drops of it may be given, in a half a glass of water, every 
three or four hours until the color of the tongue and mucous 
membrane becomes natural. 

Where the tongue and mucous membrane are purple 
or dark-red, whether there is or is not sordes on the lips 
and teeth give antiseptics, such as Naphthalin and the 
Fl. Ext. of Baptisia, or the following: 

Tr. of Iodine, 1 drachm, 

Carbolic Acid, \ drachm, 



16 THE PRACTICE OF MEDICINE. 

Gum Arabic, \ drachm, 

Water, 4 ounces. 

Mix and give a teaspoonful, in a sup of water, every 
four or six hours. 

Where there is an irritation of the stomach the tongue 
is usually elongated and pointed, the tip and edges red. 

A yellow or yellowish coating on the tongue calls for 
a cathartic, which should be given in small doses, frequently 
repeated, in order to obtain its effects gradually. We 
know of no remedy, in these cases, that answers a better 
purpose than Calomel. It may be combined with Bicar- 
bonate of Soda and powdered Ipecac, thus: 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, 1 grain. 

Mix and divide into five powders and give one of them 
every hour until all are taken. Should they fail to act 
mildly on the bowels, within ten or twelve hours, give 
Salts, Oil, or a Seidlitz Powder 

Calomel tablets containing 1-5 of a grain of the drug 
combined as in the foregoing, may be obtained at any 
first-class drug store. 

A white coating on the tongue shows that the patient 
has, or has had, fever and nothing more. In these cases 
it would probably be advisable to give an ordinary dose 
of common Salts or a Seidlitz Powder. 

If the bowels move too often, check them as you would 
in ordinary diarrhea. If they do not move often enough, 



PERIODIC DISEASES. 17 

which should be at least once in twenty-four hours, use 
such remedies as Salts, Oil or a Seidlitz Powder. 

If the patient passes too much urine check it with such 
remedies as Ergot and Rhus Aromatica; and should the 
flow be scanty increase it with the following: 

Acetate of Potash, 5 drachms, 

Water, 2 ounces. 

Mix and give a teaspoonful, in a sup of water, every 
three or four hours until the desired effects are obtained. 

Use cathartic medicines cautiously as they are very 
weakening. 

PERIODIC DISEASES. 

Any ache, pain or fever that comes on at a certain time, 
periodically, each day, may usually be cured with Quinine. 
The most successful method of using it in these conditions 
is to commence six and one-half hours before the expected 
occurrence of the ache, pain or fever, and give a number 
one capsule, well filled with the Sulphate of Quinine, every 
two hours until four are taken. Should it fail to relieve 
the patient on the first day try it on the second day and 
even the third. 

Where there is severe pain apply salt as hot as it can 
be borne, to the painful parts. 

If the pain is very severe J of a grain of the Sulphate 
of Morphine may be given; and if relief is not obtained 
in forty-five or fifty minutes, the dose may be repeated; 
but do not administer the third dose under three or four 
hours, and not then, unless it is imperatively demanded. 



i8 THE PRACTICE OF MEDICINE. 

Laudanum, Paregoric or Dover's Powder may be used 
instead of the Morphine for severe pain. 

TONICS. 
These remedies are to be used in any or all conditions 
where the patient is weakened or debilitated, especially 
after severe sickness. The following is a most excellent 
combination and will not only build up debilitated patients 
but will cure the majority of those who are suffering with 
indigestion : 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Canadensis, . . 1 ounce, 

Fowler's Solution of Arsenic, ij drachms, 

Aromatic Elixir, sufficient to make, . .6 ounces. 

Mix and give a teaspoonful before each regular meal. 
If the patient has chronic constipation add a sucffiient 
amount of the Fl. Ext. of Cascara Sagrada to each dose 
of the tonic. This will usually be from 10 to 30 drops. 

If there is swelling of the feet and ankles omit the 
Arsenic and add 3 or 4 drops of the Fl. Ext. of Apocynum 
Cannabinum to each dose of the tonic. 

If the whites of the eyes are yellow, add from 20 to 30 
drops of the Fl. Ext. of Chionanthus Virginica to each dose 
of the tonic. 

See Chronic Chills. 

RECAPITULATION. 

Normal temperature: 98 2-5. 
Temperature above 98 2-5: Fever. 
Temperature under 98 2-5, too low: Stimulants. 



RECAPITULATION. 19 

Fever, pulse too quick and too full: Aconite or 
Veratrum. 

Stomach or bowel troubles with fever and a full pulse: 
Aconite. 

High fever and full pulse: Acetanilide. 

Flushed face, bright eyes, the pupils too small: Gel- 
semium. 

Sleeping too much, the pupils too large: Belladonna. 

Pulse weak or irregular: Digitalis or Digitalis and 
Cactus. 

Tongue broad and pallid, uniformly coated with a 
filthy whitish coat: Sulphite of Soda. 

Tongue elongated, tip and edges red: Stomach irri- 
tated. 

Tongue red and dry: Hydrochloric Acid. 

Tongue dark purplish: Antiseptic. 

Tongue, yellowish coated: Cathartic. 

Periodic diseases: Quinine. 

Severe pain: Hot Applications. 

Pain, very severe: Morphine, Laudanum, Paregoric, 
Dover's Powder. 



PART II. 

FEVERS. 

Fever is a morbid condition of the system, character- 
ized by a rise of temperature above 98 2-5, quickened 
pulse, marked tissue change, and disordered secretions. 

The primary cause of fever is still an unsettled ques- 
tion. It is probably either a disorder of the sympathetic 
nervous system giving rise to disturbances of the vaso- 
motor filaments, or a morbid condition of the nervous 
centers adjacent to the corpus striatum, which by experi- 
ment, have been found to govern the process of heat pro- 
duction, distribution, and dissipation. 

All fevers are either idiopathic or traumatic. 

An idiopathic fever is one that arises as a primary 
disease, and not as a result of a local trouble, such as an 
inflammation or a wound. 

A traumatic, or symptomatic fever, is one that arises as 
a secondary affection, such as the result of a wound or an 
inflammation. 

All fevers are either sthenic or asthenic. 

A sthenic, or active fever, is one in which there is a 
preternatural manifestation of vital energy and strength 



22 THE PRACTICE OF MEDICINE. 

of the heart's action, such as is seen, the first few days, 
in acute fevers and inflammations. 

An asthenic fever is one in which there is a diminution 
of vital force, characterized by enfeebled action of the 
heart, etc., such as is seen in the latter stages of continued 
types of fevers. 

All fevers are either intermittent, remittent or 

CONTINUED. 

An intermittent fever is one in which there are paroxysms 
of fever followed by intervals of apparent health such as 
common chills. 

A remittent fever is one in which there is a temporary 
diminution or remission of the symptoms one or more times 
a day, such as is seen in bilious (?) fever. 

A continued fever is one in which there is no well- 
marked remission, such as typhoid fever. 

GENERAL TREATMENT OF FEVERS. 

Control the temperature and the circulation. 

The remedies recommended in Part I. will accomplish 
this very nicely. 

"The cold bath or cold pack reduces temperature 
most decidedly, but entails much labor and is not altogether 
free from danger. ' ' — Hughes . 

Do not undertake to reduce fever too rapidly as patients 
cannot bear the remedies, besides it is not beneficial; but 
rather undertake to control the circulation and temper- 
ature. 

Keep the patient clean. This may be accomplished by 
sponging the entire body with tepid water once a day. 



INTERMITTENT FEVER 23 

If the urine is scanty use diuretics; and if the bowels 
are constipated give laxatives. 

Let fever patients have plenty of water, as it is beneficial 
in promoting the various secretions. 

Let everything you do in all fevers, or other diseases, 
have a tendency to check, or bring back to a natural con- 
dition something that is varying from a normal condition. 
If you do more than this you will do harm and if you do 
less, you will fail to do your full duty. 

Nourish the patient. Do not starve a fever. Administer 
milk, beef-tea, chicken-tea, and other light nutritious 
food, in small quantities, but at frequent intervals. 

Examine the stools so that you may judge whether 
the food is being digested. 

Attend to the nursing. Much of the success in the 
management of fever-patients can be attributed to good 
sensible nursing. Through nursing are secured the five 
essentials of every sick-room, to- wit: cleanliness, cheerful- 
ness, regularity, ventilation and light. 

INTERMITTENT FEVER. 

MALARIAL FEVER; CHILLS AND FEVER; AGUE; SWAMP FEVER. 

A non-contagious, infectious disease; characterized by 
a cold, a hot, and a sweating stage. The cold stage is 
frequently absent, or so mild that it can not be detected. 

When the attacks occur every day it is called quotidian; 
when every other day, tertian and when occurring the first 
and fourth days quartan. 

It is caused by the presence in the blood of the 
haematoza of Laveran. This parasite, it is now believed, 



24 THE PRACTICE OF MEDICINE. 

is transmitted to man by certain species of mosquitoes 
(genus Anopheles) that have fed on the blood of some 
one affected with malaria. 

Symptoms: An attack usually begins with drowsiness 
and a disposition to yawn, and a feeling of chilliness, 
which, in severe cases, increases until it amounts to rigors 
with chattering of the teeth. The lips and finger-tips now 
have a bluish appearance, and if the skin is examined it 
will be noticed that it resembles that of a " picked 
goose." In some, there is vomiting, sometimes of bilious 
matter. 

This condition usually lasts from a few minutes to one, 
two, or three hours and gives way to the hot stage, which 
commences with flushes of heat. The fever now rises 
rapidly, usually attaining 104 or 105, rarely 106 degrees. 
There is considerable thirst, pain in the back and limbs 
and severe headache. The pulse is full and bounding, 
the face flushed and the pupils contracted, indicating active 
congestion of the brain. 

In other cases, the patient is drowsy, dozing, or sleep- 
ing a good deal of the time, the pupils being too large, 
indicating passive congestion of the brain. 

Children not infrequently have spasms during the hot 
stage of intermittents. 

This condition lasts from one, to sixteen or eighteen 
hours, and gives way to the sweating stage. It will be 
noticed that the hands and forehead are moist. The 
fever now subsides rapidly and the patient is soon covered 
with perspiration, and, with the exception of a feeling of 



INTERMITTENT FEVER 25 

weakness, he is comparatively well until another paroxysm 
occurs. 

Treatment: Prophylaxis. "The investigations cited 
above show that an individual ill of malaria is a source 
of danger in a community, and should be promptly treated. 
Localities that furnish breeding-places for the mosquito 
(e. g. f marshes) should be thoroughly drained. The 
homes and more particularly the sleeping-apartments, 
of persons residing in paludal regions, should be protected 
against invasion by mosquitoes." — Anders. 

During the cold stage put the patient to bed and apply 
plenty of cover, and if this stage is very severe place hot 
rocks, hot bricks, or anything that is calculated to retain 
heat, around the patient and you may also give 10 or 15 
drops of the Tr. of Camphor or a half- teaspoonful of the 
Aromatic Spirits of Ammonia, in a sup of water. This 
will bring "about a reaction, however, there is seldom any 
treatment required in this stage of an ordinary inter- 
mittent. 

When fever comes up, if there is a full bounding pulse, 
give one drop of the Tr. of Veratrum Viride every hour 
or every hour and a half. If there is flushed face, bright 
eyes, and contracted pupils, add i\ drops of the Fl. Ext. 
of Gelsemium to each dose of the Veratrum, thus: 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful of the mixture at a dose.' 

If the stomach is irritated use Aconite instead of the 



26 THE PRACTICE OF MEDICINE. 

Veratrum; and if the patient is sleeping too much, the 
pupils being too large, add J of a drop of the Fl. Ext. of 
Belladonna to each dose of the Aconite, as follows: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful of the mixture every hour 
and a half or two hours while there is fever. 

Instead of using the foregoing, especially where there 
is no passive congestion of the brain, you might give from 
3 to 5 grains of Acetanilide every three or four hours while 
there is fever. 

Where children are having spasms from congestion 
of the brain, give them the indicated fever drops every 
half-hour until they are relieved. At the same time keep 
the head cool. Pour cold water on it sufficiently often 
to accomplish the desired result. If the feet are cold bathe 
them in warm water, then, wrap them up well with a 
blanket and apply hot irons, bricks, or anything that will 
retain heat, to them. If the foregoing should fail to control 
the spasms, give a dose of Chloral Hydrate every half-hour 
until relief is obtained. The dose of Chloral is one grain 
for each year of age up to twenty. It should be given in 
strong mint-water. 

If the tongue is coated with a yellowish coat give the 
following : 

Calomel, i grain, 

Bicarbonate of Soda, io grains, 

Powd. Ipecac, i grain. 



CHRONIC INTERMITTENT. 27 

Mix and divide into five powders and give one every 
hour until all are taken. Should they fail to act on the 
bowels, follow them with Salts, Oil or a Seidlitz Powder. 

Instead of the Calomel mixture the Improved Compound 
Cathartic Pills may be used. The proper way to use them 
is to take one at night and if it does not act mildly on the 
bowels take another one the next morning. Do not use any 
cathartic medicine at all unless it is particularly indicated. 

Commence six and one-half hours before the next, 
expected chill-time and give 5 grains of the Sulphate of 
Quinine every two hours until four doses are taken. The 
Quinine may be made more efficient and less disagreeable 
by the addition of one or two grains of Dover's Powder 
to each dose. 

Where you do not know when to expect the chill, keep 
the patient under the influence of the Quinine until there 
is no probability of a paroxysm. 

The following form of Quinine should be used with 
children, as it is tasteless: 

Quinidine (Alkaloid), 1 \ drachm, 

Simple Syrup, 2 ounces. 

Mix and remember that a teaspoonful of it contains 
5 grains, the proper dose for an adult. Quinidine is said 
to be more efficient in malaria than Quinine (Potter). 
(See Chronic Chills.) 

CHRONIC INTERMITTENT. 
chronic chills; chronic malaria; chronic ague. 
Chronic malaria is produced by the same causes that 
produce the acute variety of the disease and never occurs 



28 THE PRACTICE OF MEDICINE. 

except as a result of neglected or improperly treated cases 
of the acute form. After the condition has existed for some 
time the patient has a sallow appearance, the spleen enlarges, 
the abdomen bloated and the lips have a pale char- 
acteristic color. 

Where an acute attack of chills has been broken and 
afterwards returns, it might for all practical purposes be 
classed as chronic. It would probably be well for us to 
add that in chronic malaria the attacks are frequently 
irregular, and, sometimes the spleen becomes enormously 
enlarged. 

Treatment: Check the attacks with Quinine as you 
would in ordinary acute intermittents. If the patient is 
a child, use Quinidine instead of Quinine. 

If particularly indicated use the following : 

Calomel, i grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, i grain. 

Mix and divide into five powders and give one every 
hour until all are taken. Should they fail to act mildly 
on the bowels give Salts, Oil or a Seidlitz Powder. 

If preferred, Improved Compound Cathartic Pills may 
be used instead of the Calomel-mixture. Give one at 
night, and if it does not act mildly on the bowels by morning, 
give another one. Bear in mind that the disease cannot 
be cured by any kind of laxative or cathartic medicine. 
The patient must be built up. 

After an experience extending over many years, in an 
intensely malarial region, we are prepared to state that the 



CHRONIC INTERMITTENT 29 

following tonic when taken as directed,, and treatment is 
used as herein given for complications that may be present, 
will never disappoint you : 

Quinidine (Alkaloid), 3 drachms, 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fowler's Solution of Arsenic, i\ drachms, 

Simple Syrup, sufficient to make, 6 ounces. 

Mix and give a teaspoonful before each regular meal. 
If the feet and ankles are swollen, omit the Arsenic and 
add 3 drachms of the Fl. Ext. of Apocynum Cannabinum 
in its stead. 

Occasionally, especially where patients have suffered 
with chronic malaria, more or less, for several months or 
even years, there may be no regular chills or fevers. In 
these cases, the skin and lips have a characteristic pale 
color; the stomach and abdomen are hard and larger than 
natural ; the spleen and liver are enlarged ; there is shortness 
of breath; and, in many cases, swelling of the feet and 
ankles. In such cases, it is necessary to use the foregoing 
tonic, together with the treatment recommended for the 
various complications, until the patient regains his usual 
health. This is, usually, from six weeks to six months. 
If the patient's eyes are yellow, in addition to the 
foregoing tonic, give 30 drops of the Fl. Ext. of Chio- 
nanthus Virginica after each regular meal. 

If the tongue is coated with a filthy, whitish, pasty 
coat give 20 grains of the Sulphite of Soda every four 
hours until it is clean. 



30 THE PRACTICE OF MEDICINE. 

If the tongue is redder than natural give 2 or 3 drops 
of Hydrochloric Acid, largely diluted with water every 
four hours until its color becomes normal. 

If the bowels are constipated give a sufficient amount 
of the Fl. Ext. of Cascara Sagrada after each regular meal 
to regulate them. 

It is not uncommon to find children whose stomachs 
are so delicate that it is impossible for them to take the 
tonic previously recommended. In such cases the following 
will usually be sufficient: 

Quinidine (Alkaloid), 1 drachm, 

Colorless Fl. Ext. of Hydrastis Can., 3 drachms, 

Fowler's Solution of Arsenic, £ drachm, 

Simple Syrup, sufficient to make, 2 ounces. 

Mix. The dose for an adult is a teaspoonful 
before each regular meal, children in proportion to 
age. 

Patients suffering with chronic malaria should have 
the most nutritious food that can be obtained and 
allowed to eat as much of it as they are able to 
digest. 

Hypertrophy of the Spleen: Ague cake, or enlarge- 
ment of the spleen is usually a result of chronic malaria, 
therefore, we will notice it in connection with chronic 
intermittent. 

The spleen is sometimes enlarged to such an extent 
that it is difficult to pass the fingers under its outer border 
even in the right iliac region. 



CHRONIC INTERMITTENT. 31 

Reputable physicians have been known to diagnose 
such cases as abdominal dropsy. A few such cases have 
come under our observation. 

Treatment : In addition to the treatment recommended 
for chronic malaria apply a Compound Tar Plaster (Irritat- 
ing Plaster) over the region of the spleen, making it large 
enough to extend as far over the abdomen as the enlarged 
organ extends. Spread the material composing the plaster 
on thin, pliant leather or very thick cloth. The can con- 
taining it should be placed in a vessel of warm water until 
it is thoroughly softened, when, it may be easily spread, 
after which it should be applied to the body warm. Allow 
it to remain on the body until the region over which it is 
applied becomes so sore that it cannot be longer borne, 
when, it may be removed for a few days and applied again 
as before and thus continued until a complete cure is 
effected. 

The following will answer in some cases instead of the 
Tar Plaster, but it is an inferior remedy: 

Croton Oil, \ ounce, 

Olive Oil, \ ounce. 

Mix and apply over the region of the spleen each day 
with a feather until the parts become as sore as can be 
borne, when, the applications may be discontinued for a 
few days; when, it should be used as before and thus con- 
tinued until a complete cure is effected. 

In addition to the counter-irritant over the region 
of the spleen, give the following: 



32 THE PRACTICE OF MEDICINE. 

*F1. Ext. of Grindelia Squarrosa, .... 3 ounces, 

Fl. Ext. of Polymnia Uvedalia, 2 ounces, 

. Aromatic Elixir, sufficient to make,. .6 ounces. 

Mix and give a teaspoonful after each regular* meal. 
If the Grindelia Squarrosa cannot be obtained, use the 
Polymnia Uvedalia without it. 

Do not expect results at once, but continue the treatment, 
if necessary for months, and you will surely be rewarded 
by a permanent cure, and that without emigrating to the 
mountains to obtain it. 

Floating Spleen : This condition is rarely seen, and if 
the spleen were not enlarged would probably never be de- 
tected. The organ appears to be attached at its base by 
a rather small pedicle and the dependent portion may be 
found knotted in almost any part of the abdominal 
cavity. 

Treatment: This should be the same as that recom- 
mended for enlargement of the spleen. 

CONGESTIVE INTERMITTENT. 

CONGESTIVE CHILL; PERNICIOUS MALARIA. 

This is a malignant, destructive form of intermittent 
fever; characterized by intense coldness of the surface of the 
body, cold breath, slow, feeble pulse and persistent thirst. 

It is caused by the presence in the blood of the 
haematozoa of Leveran. 



' Do not allow your druggist to make you believe that Grindelia or Grindeli" 
Robusta and Grindelia Squarrosa are the same thing, for they are not. The Fl. 
Ext. of Grindelia Squarrosa may be obtained from Lloyd Bros., Cincinnati, 
Ohio, and also from The William S. Merrill Chemical Co., of the same city. 



CONGESTIVE INTERMITTENT. 33 

Symptoms: Frequently an attack is preceded by one 
or more ordinary chills; in others, the first chill is severe 
and alarming; the temperature of the surface greatly 
diminished; the skin pale and shrunken, sometimes covered 
with a clammy sweat; the tongue usually pale and clean, 
in some cases, coated with a white fur; and in severe cases, 
it is cold. 

Vomiting is common; sometimes of blood or a oloody, 
watery fluid. The pulse is weak or irregular, sometimes 
slow. Breathing is difficult; and, in extremely severe 
cases, the breath is cold. In some, there is diarrhea, the 
discharges consisting of bloody water; in others, there is 
haemorrhage from the kidneys. 

After from three to five hours, reaction slowly takes 
place, when, the paroxysm is at an end. 

High fever with severe congestion of the brain sometimes 
follows, though, this is rare; or the system failing to react 
the patient dies. 

Unless prevented by treatment, at the same or an earlier 
hour the next day the chill returns and is more severe 
than the first one. Few people ever recover from the 
third one . 

Treatment: As soon as the nature of the attack 
is discovered, put the patient to bed, cover him up well and 
give a tablespoonful of Whiskey, or a teaspoonful of the 
Aromatic Spirits of Ammonia, every hour, in § of a table- 
spoonful of strong pepper-tea. If the Whiskey or Ammonia 
is not at hand give 20 drops of the Tr. of Camphor. The 
applications of hot rocks, hot bricks, hot irons, bottles filled 



34 THE PRACTICE OF MEDICINE. 

with hot water, etc., to the feet, limbs and body must not 
be neglected. 

If the case is a very severe one, in addition to the remedies 
and the hot applications just mentioned, the patient should 
be wrapped with a blanket wrung out of hot water, which 
has had a sufficient quantity of Mustard and Pepper added 
to it to make it strongly stimulating, and 1-60 of a grain 
of the Sulphate of Atropine and 1-20 of a grain of the 
Sulphate of Strychnine should be given hypodermically. 

As soon as a sense of warmth is felt in the stomach give 
20 grains of Quinine every hour until there is complete 
reaction. 

If fever comes up, control it as you would in simple 
intermittent. 

After there is complete reaction established, the great 
object to be attained is to prevent a recurrence of the 
paroxysm. To accomplish -this Quinine must be given in 
10-grain doses every three hours until the expected chill- 
time has passed. After having prevented a recurrence of 
the chill, give the patient the tonic recommended for chronic 
chills until his former strength is regained. 

REMITTENT FEVER. 

MALARIAL FEVER; BILIOUS FEVER. 

Remittent fever is an infectious non-contagious, par- 
oxysmal disease with exacerbations and remissions, the 
temperature remaining above normal ; characterized by 
a cold stage, not recurring after the first paroxysm; an 
intense hot stage, accompanied by severe pains in the head, 
back and limbs; more or less vomiting, followed by an 



REMITTENT FEVER. 35 

almost imperceptible sweating stage, which is not infrequently 
wanting. 

It is caused by the presence in the blood of the haematoza 
of Leveran of the aestivo-autumnal variety, which is 
communicated to man by the mosquito. 

Symptoms: There is usually a feeling of drowsiness, 
with loss of appetite, and, in some cases, headache for two 
or three days before the attack. In rare instances, the 
first thing noticed is the chill, which resembles that of an 
ordinary intermittent. Fever soon follows, the temperature 
usually reaching 104 or 105 degrees, rarely 106. There 
is thirst, and, in many cases, vomiting, sometimes of bile. 
Restlessness with headache, pain in the back, and limbs is 
common. 

The pulse is quickened and usually full and strong; 
the face flushed; the eyes bright and the pupils contracted, 
indicating active congestion of the brain. In other cases 
the pupils are too large, the patient dozing or sleeping a 
good deal of the time, probably with the eyes partly open, 
the head being hot and the feet and hands inclined to be 
cold, indicating passive congestion of the brain. 

The tongue, in some cases, is coated with a yellowish 
fur; while in others, it is broad and pallid, the coating 
consisting of a dirty whitish material. There is still 
another class of cases, especially those bordering on a 
continued type of fever, in which the tongue is red and 
dry. 

The fever, as a rule, lasts from eight to twenty-four 
hours and gradually goes down to 99 or 100, when the 



36 THE PRACTICE OF MEDICINE. 

patient feels considerably better, and the skin may become 
moist. This condition which is the remission, usually 
lasts from two to six hours, when, the hot stage returns, 
though, generally, minus the chill, and there are the same 
symptoms as on the previous day, which is in turn again 
followed by the remission. Thus the disease continues 
from five to eight days and terminates in convales- 
cence. 

In severe or badly treated cases, the fever not infre- 
quently assumes a continued type, when, it is sometimes 
called typho-malarial fever, but erroneously. The symp- 
toms of this are similar, minus the bowel trouble, to 
typhoid fever, which see. 

Treatment: This should be commenced by the 
administration of the proper sedatives (fever-drops). Thus 
if the pulse is full and strong, and the stomach not irritated, 
give one drop of the Tr. of Veratrum, and if the face is 
flushed, the eyes bright and the pupils contracted, add one 
and one-half drops of the Fl. Ext. of Gelsemium to each 
dose of the Veratrum as follows: 

Tr. Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half while 
there is fever. In addition to this 5 grains of Acetanilide 
may be given every three or four hours while the fever is 
high. 

If the stomach is irritated, use Aconite instead of the 
Veratrum, adding the Gelsemium, if indicated. Or, if the 



REMITTENT FEVER. 37 

patient is drowsy, the pupils being too large, use Belladonna 
instead of the Gelsemium, as follows: 

Tr. Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half 
while there is fever. 

Keep the head cool and the feet and hands warm. 
If the tongue is coated with a yellowish fur, give the 
following : 

Calomel, i grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, i grain. 

Mix and divide into five powders, and give one of them 
every hour until they are all taken. Should they fail to 
act on the bowels, give Salts, Oil or a Seidlitz Powder. 
The Calomel-preparation is very useful in quieting an 
irritated stomach. If preferred the Improved Compound 
Cathartic Pills may be used instead of the Calomel; how- 
ever, not more than one of them should be given at a dose ; 
but, if needed, it may also be followed by a laxative. 

If the tongue is broad and pallid, the coating consisting 
of a dirty whitish, pasty material, give 20 grains of the 
Sulphite of Soda every four hours until the tongue becomes 
normal in appearance. 

Where the tongue is of a deep-red color, give 3 drops of 
Hydrochloric Acid, largely diluted with water, every four 
hours until the tongue assumes its natural color. 

Vomiting, when present, may usually be overcome by 



38 THE PRACTICE OF MEDICINE. 

the application of a mustard-draft over the region of the 
stomach and the administration of a Creosote Compound 
Tablet every hour. This tablet may be obtained of any 
first-class druggist. Should these means fail, treat the 
stomach as recommended in irritation of the stomach, 
which see. 

As soon as the -temperature is down to something near 
normal, give 5 grains of Quinine every hour and a half 
until the fever begins to rise, when it should be discontinued 
and the " fever drops" given as before until the fever gives 
way sufficiently to use the Quinine again. 

If the kidneys fail to act as freely as they should give 
20 grains of the Acetate of Potash every three or four hours, 
as is necessary. 

Continue the treatment as directed until the fever finally 
gives way, when the Quinine should be given every four 
hours for a day or two, then, put the patient on the tonic 
recommended for chronic chills until the former health 
is regained. 

Should the fever assume a continued type treat it as 
you would typhoid fever, which see. 

MALARIAL HEMATURIA. 

THE YELLOW DISEASE. 

An infectious, non-contagious, malignant, malarial fever; 
characterized by a chill, fever, nausea, vomiting, difficult 
breathing, intense yellowness and bloody urine. 

Caused by the presence in the blood of the haematozoa 
of Laveran, usually of the Aestivo-Autumnal variety, 



MALARIAL HEMATURIA. 39 

which gains entrance into the system by means of the 
infected mosquito. 

Symptoms: In the majority of instances the patient 
has suffered with chronic malaria for some time before the 
occurrence of the attack, which commences with a chill 
more or less severe in character. Fever either of an inter- 
mittent or remittent type follows, rarely reaching more 
than 103 or 105 degrees. There are more or less nausea 
and vomiting with severe pains in the region of the liver 
and kidneys. This condition continues a few hours when 
bloody urine is voided; and the patient suddenly turns 
extremely yellow, after which an intermission* or a remission 
occurs with considerable abatement of the symptoms. 
Sooner or later a second paroxysm occurs, which is more 
severe than the first. Patients are sometimes very nervous 
and restless, again they are stupid or drowsy; the tongue 
is red and dry; sordes appear on the teeth and lips; the 
pulse becomes weak and irregular; the urine is suppressed; 
the breathing is difficult; and death soon closes the scene. 

In other cases the urine becomes clear, the mouth moist, 
the tongue, lips and teeth clean, the yellowness disappears, 
and the patient is convalescent, but very much debilitated. 

Treatment: The disease is easier prevented than 
cured. No case of malaria should be neglected or allowed 
to become chronic. 

At the beginning of the attack give Calomel, thus : 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, , 1 grain. 



40 THE PRACTICE OF MEDICINE. 

Mix and divide into five powders and give one every 
hour until all are taken. Should they fail to act on the 
bowels give Salts, or a Seidlitz Powder. 

Control the fever as you would in any other disease, 
however, as the stomach is very liable to be irritable it 
would probably be best to use Aconite instead of Veratrum 
in all cases where the pulse is too full and too strong. If 
the patient is restless, the face flushed, the eyes bright, 
and the pupils contracted, add Gelsemium to the Aconite, 
as follows : 

Tr. of Aconite Root, 18 drops, 

Ext. of Gelsemium. 27 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half while 
there is fever. 

If the fever is high 5 grains of Acetanilide may be given 
every three or four hours, however, its action must be closely 
watched and its use discontinued if it depresses the patient 
too much. 

If the patient is drowsy, the pupils being too large, 
Belladonna should be used instead of the Gelsemium, thus: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water,. 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half. 
If the pulse is weak and irregular use Digitalis and 
Cactus, as: 

Fl. Ext. of Digitalis, 12 drops, 



MALARIAL HEMATURIA. 41 

Fl. Ext. of Cactus Grandinorus, 24 drops, 

Water, 12 teaspoonfuls. 

Mix and give a teaspoonful every two hours until the 
pulse becomes normal. If indicated, the Belladonna 
should be added to the Digitalis-mixture. 

For the purpose of checking the hemorrhage and stimu- 
lating the liver use the following: 

Fl. Ext. of Ergot, 5 J drachms, 

Fl. Ext. of Rhus Aromatica, 53 drachms, . 

Fl. Ext. of Chionanthus Virginica, 53 drachms. 

Mix and give a teaspoonful, in a sup of water, every 
four hours. 

As soon as the intermission or remission occurs give 5 
grains of the Alkaloid Quinidine every hour and a half. 
Should the fever remain down after four doses of the Quini- 
dine have been taken give it every four hours. Should 
the fever rise after having commenced the administration 
of the Quinidine discontinue it until the temperature is 
something near normal again. If the Quinidine cannot be 
obtained use the Sulphate of Quinine in the same dose. 

Where the breathing is difficult and the pulse weak 
1-40 to 1-30 of a grain of the Nitrate of Strychnine should 
be given every three hours. 

The Aromatic Spirits of Ammonia may be given, in 
connection with the Strychnine where the patient is greatly 
prostrated. It may be given in 30-drop doses every one 
or two hours. 

If there is suppression or scantiness of urine use the 
following: 



42 THE PRACTICE OF MEDICINE. 

Acetate of Potash, 5 drachms, 

Water, sufficient to make, 2 ounces. 

Mix and give a teaspoonful in a sup of water, every 
three hours. 

If there is vomiting give the patient a Creosote Compound 
Tablet every hour until relieved. Or, the following: 

Subnitrate of Bismuth, 1 drachm, 

Oxalate of Cerium, 20 grains. 

Mix and divide into ten powders and give one of them 
in Mint- Water every hour until the stomach is quieted. 
See irritation of the stomach. 

Do not allow the bowels to become constipated during 
the attack. 

Finally when convalescence is fully established give the 
tonic recommended for chronic chills until the patient's 
natural stage of health is regained. 

FEBRICULA. 

IRRITATIVE FEVER. 

This is a fever of the continued type, very mild in 
character and rarely lasting longer than from three to five 
days. Those who are unacquainted with it are fre- 
quently led to believe that they have some grave dis- 
ease, on account of the fever, which is exceedingly high. 

It is especially a disease of childhood, however, adults 
are not exempt from it. Its most frequent causes are thought 
to be excesses in eating and drinking, exposure to the sun, 
excitement and the action of cold. 

Symptoms: The symptoms of febricula are those com- 
mon to all fevers; the patient has a chill of longer or shorter 



FEBRICULA. 43 

duration but usually of not much severity. Preceding 
the chill there will be observed, sometimes for a few days, 
that the child is dull and languid, cross, or that it sleeps 
more than usual. Following the chill the pulse increases 
in frequency as the temperature becomes higher; the 
secretions are checked and there is more or less excitement 
of the nervous system. The febrile reaction comes up 
rapidly and usually attains its greatest intensity in from two 
to four hours. It may continue to the termination of the 
disease as a continued fever, or it may be broken up into 
exacerbations and remissions. 

The natural duration of the disease is from three to five 
days, the fever gradually declining during the last third of 
the time, and, finally, terminating by the establishment of 
free secretion. In some cases, during the progress of the 
disease, there is passive congestion of the brain. The 
patient sleeps too much, sleeps with the eyes partly open, 
the pupils being too large; the head hot and the feet and 
hands cool. Children may have convulsions. 

In other cases, there is active congestion of the brain; 
the patient is restless; the face flushed, the eyes bright, and 
the pupils contracted. 

Treatment: Control the fever. If the pulse is full 
and strong and the stomach not irritated give Veratrum, 
and, if there is active congestion of the brain, add Gel- 
semium, thus: 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, 18 teaspoonfuls. 



44 THE PRACTICE OF MEDICINE. 

Mix and give a teaspoonful every hour and a half while 
there is fever. 

If the stomach is irritated use Aconite, adding the Gel- 
semium; or if there is passive congestion of the brain use 
Belladonna, thus: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half. 

If the stomach is irritated, apply a Mustard- Plaster 
over its region and give a Creosote Compound Tablet 
every hour until relieved. See irritation of the stomach. If the 
bowels are constipated give Oil, Salts or a Seidlitz Powder. 

Where patients are having convulsions give them the 
indicated " fever-drops " every half- hour until three or four 
doses are taken, or until they are relieved. Keep the head 
cool; pour cold water on it, if necessary, in order to accom- 
plish the desired result. If the feet are cold, bathe them 
in hot water, then, after wrapping them up well with a 
blanket apply a hot iron to them. 

Should these means fail to control the convulsions 
give Chloral Hydrate every half-hour. The dose of it is 
one grain for each year of age of the patient up to twenty. 

Where the fever is high and the pulse strong Acetanilide 
may be used in this, as well as other fevers. 

TYPHOID FEVER. 

SLOW FEVER. 

An acute infectious, non-contagious fever of an average 
duration of from three to four weeks; characterized by a 



TYPHOID FEVER. 45 

slow, insidious onset; bleeding from the nose; more or less 
stupor and delirium; red- tongue becoming dry, brown, and 
sometimes fissured ; a tympanitic condition of the abdomen, 
diarrhoea; an eruption on the bowels; great prostration and 
a slow convalescence; a lesion of Peyer's patches, the 
mesenteric glands and the spleen. 

The disease is caused by the bacillus of Eberth, which 
gains entrance into the system through contaminated water, 
milk or other food. 

Symptoms : The stage of incubation is usually of several 
days' duration, the symptoms being those of depression. 
The patient complaining of headache, dizziness, loss of 
appetite, disturbed sleep and muscular weakness, with, 
not infrequently, bleeding from the nose. This condition 
exists from a few days to two or three weeks and is usually 
followed by a chill or chilliness of variable duration, the 
patient being unable to designate the exact day when the 
symptoms first began. 

In malarial districts the disease not infrequently begins 
abruptly with a chill or rigor, which is followed by high 
fever. In these cases, the fever is usually of a distinctly 
remittent type during the first few days, the temperature 
reaching 90^ degrees during the early morning and running 
as high as 104 or 105 degrees during the evening. This 
condition usually continues from four to eight days, when, 
the malarial element of the disease gives way and there 
is, from this time on, a typical case of typhoid fever. 

Where the disease is uncomplicated, from the initial 
chill the fever gradually rises day by day, the evening 



46 THE PRACTICE OF MEDICINE. 

temperature being a degree or two higher than that of 
the morning. 

The tongue is now coated; its tip and edges red and, 
in some instances, appearing as if they were glazed. The 
pulse is quick, full and strong; the bowels are tympanitic 
and a gurgling sound may be elicited by deep pressure in 
the right iliac fossa (inside of the right hip bone). In 
some, in. fact a majority, there is diarrhoea, while in others 
the bowels are constipated and remain so throughout the 
attack. About the seventh day a few reddish spots re- 
sembling flea-bites may appear upon the abdomen, chest, 
or back. 

During the second week the foregoing symptoms are 
aggravated; the fever is continuous; the pulse quick and 
full; the abdomen tender and tympanitic; there is severe 
and persistent headache; often stupor and nocturnal 
delirium; more or less cough; irregular muscular con- 
tractions (subsultus tendinum), especially of the wrists; 
sordes appear upon the lips and teeth; the tongue 
becomes clean and more or less dry; diarrhoea continues 
and during this stage deafness sometimes develops and 
may continue into convalescence. The spleen increases in 
size and there may be disturbances in vision. 

About the third week the fever becomes remittent, but 
the evening temperature continues as high as in the pre- 
ceding week, the morning temperature becoming lower 
each day. The pulse is now usually weak and frequently 
irregular; and the patient is greatly emaciated. All 
other symptoms remain about the same until near the 



TYPHOID FEVER. 47 

close of the week, when there is a general improvement. 

During the fourth week the temperature may be normal 
of mornings. In such cases the pulse becomes stronger 
and more regular; the diarrhoea ceases; the tongue becomes 
clean and moist; the appetite ravenous; and the patient 
passes into a slow convalescence. 

Not infrequently the fever continues from six to ten 
or more weeks and the patient dies from weakness or 
finally recovers. 

In severe cases during the second or third week the 
diarrhoea is usually troublesome ; and there may be alarming 
or fatal intestinal haemorrhage. The patient sometimes 
passes into a stupor from which it is difficult or impossible 
to arouse him; there are involuntary discharges from the 
kidneys and bowels; dark-colored sordes appear on the lips 
and teeth; the patient lies on the back with the mouth and 
eyes open; the pulse is very rapid, weak and irregular; 
and death shortly closes the scene. 

Once in a great while a case is complicated with parotid 
abscess, which is a very grave complication. 

Perforation of the bowel almost always terminates in 
peritonitis and death. 

Of course, any case of typhoid fever may be complicated 
with pneumonia, bronchitis, nephritis, phlegmasia dolens, 
etc. 

The principal pathological condition we have to deal 
with in typhoid fever is an inflammation, followed by 
ulceration of Peyer's glands in the small intestines and a 
general catarrhal condition of the large and small bowel. 



48 • THE PRACTICE OF MEDICINE. 

Treatment: "The reduction of temperature is one 
of the most important indications in the majority of cases 
of typhoid fever. There is now no doubt that the former 
views regarding the amount of fever a patient could stand 
for one or two weeks are responsible for the high mortality 
in this disease. A temperature of 103 to 105 for a dozen 
days is dangerous and should be combatted." — Hughes. 
If the pulse is quick, full and strong and the stomach 
not irritated give one drop of the Tr. of Veratrum Viride 
every hour and a half. If the stomach is irritated use 
Aconite instead of the Veratrum, and where there is active 
congestion of the brain add Gelsemium and where the nature 
of the attack is known Echinacea should be added to the 
sedative, thus : 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Fl. Ext. of Echinacea, 6 drachms, 

Water, 12 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half. Do 
not forget to use Aconite instead of the Veratrum if the 
stomach is irritable or the bowels loose, and where there 
is passive congestion of the brain Belladonna must be used 
instead of the Gelsemium, thus: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Fl. Ext. of Echinacea, 6 drachms, 

Water, ....12 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half. 
Keep the head cool and the feet warm. The former 



TYPHOID FEVER. 49 

may be accomplished by means of cloths wrung out of cold 
water and applied to the head-, changing them frequently; 
and the latter, by bathing the feet in hot water and then 
wrapping them up and applying heat to them. 

Where the pulse is quick and full and there are no 
indications of passive congestion of the brain from 3 to 5 
grains of Acetanilide may be given every four hours while 
the fever is high. 

At any time the pulse becomes weak or irregular dis- 
continue the Veratrum or Aconite and give Digitalis and 
Cactus, adding the Echinacea, thus: 

Fl. Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grandiflorus, 24 drops, 

Fl. Ext. of Echinacea, 6 drachms, 

Water, 6 teaspoonfuls. 

Mix and give a teaspoonful every two hours. If there 
is passive congestion of the brain Belladonna should be 
added to the foregoing preparation. 

At the commencement of the attack, if indicated, the 
following may be given: 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, ... 1 grain. 

Mix and divide into five powders and give one every 
hour. If they fail to act on the bowels give Salts, Oil or 
a Seidlitz Powder. 

Throughout the attack see that the bowels act at least 
once in twenty-four hours. Oil is probably our best 
laxative in typhoid fever. 



5 o THE PRACTICE OF MEDICINE. 

Should the abdomen become tympanitic relief may 
usually be obtained by moving the bowels rather freely. 
As soon as it is determined that you have a case of 
typhoid fever to deal with put the patient on the following 
antiseptics, changing from one to another as the case seems 
to demand, taking into consideration, to some extent, 
the whim of the patient. 

Carbolic Acid, 48 drops, 

Tr. of Iodine, 96 drops, 

Gum Arabic, 1 drachm, 

Water, 6 ounces. 

Mix and give a teaspoonful every four or six hours. 
In preparing this preparation first dissolve the Gum Arabic 
in water, then, add the other drugs. 
Or: 

Naphthalin, 30 grains, 

Sugar of Milk, 30 grains. 

Mix and divide into six powders and give one of them 
every four or six hours. 
Or: 

Spirits of Turpentine, 1 drachm, 

Gum Arabic, 30 grains, 

Water, 4 ounces. 

Mix and give a teaspoonful every four or six hours. 
Or, if the tongue is red and dry: 

Hydrochloric Acid, 2 drachms, 

Water, 6 ounces. 

Mix and give a teaspoonful, in a sup of water, every 
three or four hours. 



TYPHOID FEVER. 51 

Salol, in doses of 5 grains in capsules, every four hours, 
is also a valuable antiseptic in these cases. 

Baptisia Tinctoria is also a very valuable antiseptic 
in typhoid fever, one or two drops of the fluid extract of it 
may be added to each dose of Aconite or Digitalis 
mixtures. 

If the patient is unable to sleep the following may be 
given : 

Chloral Hydrate, 2 \ drachms, 

Tr. of Peppermint, \ drachm, 

Water, 2 ounces. 

Mix and give a teaspoonful, in a sup of water, every 
hour until the desired results are produced. 

Attacks that commence with a chill followed by high 
fever, showing a malarial complication, should, until the 
malarial element of the disease is controlled, be treated 
with full doses of Quinine as in remittent; but after this is 
accomplished, Quinine is worse than useless, in fact it is 
harmful, as it produces severe nervousness, etc. 

Where there is scantiness of urine Acetate of Potash 
may be given, thus: 

Acetate of Potash, 5 drachms, 

Water, , . 2 ounces. 

Mix and give a teaspoonful, in a sup of water, every 
three or four hours. If the patient is taking Hydrochloric 
Acid, 20 or 30-drop doses of the Fl. Ext. of Buchu should 
be given instead of the Potash, which is incompatible 
with any of the strong Acids. 



52 THE PRACTICE OF MEDICINE. 

Where patients are unable to discharge the urine, the 
bladder must be relieved by the use of a catheter. 

If the stomach is irritable, the patient vomiting, place a 
Mustard-Plaster over the region of the stomach and give 
a tablet of Creosote Compound every hour until relief is 
obtained. See Irritation of the Stomach. 

Where there is diarrhoea, especially if there is more 
than four or five discharges from the bowels, in the course 
of twenty- four hours, give io-grain doses of the Subnitrate 
of Bismuth after each discharge. Should this fail, trv the 
following : 

Subnitrate of Bismuth, i drachm, 

Powd. Bay Berry Bark, i drachm, 

Sulphocarbolate of Zinc, 18 grains. 

Mix and divide into six powders and give one every 
three or four hours as is necessary. The following is 
also very beneficial in these cases: 

Subnitrate of Bismuth, ij drachms, 

Fl. Ext. of Bay Berry, 4 drachms, 

Paregoric, sufficient to make, .2 ounces. 

Mix and give a teaspoonful every three or four hours. 

Haemorrhage, when present, may usually be controlled, 

by the administration of half-teaspoonful doses of the 

FL Ext. of Ergot every half-hour or so as the occasion 

demands. 

Where the pulse is weak, or weak and irregular, the 1-40 
of a grain of the Nitrate of Strychnine should be given every 
three or four hours. It may be given in connection with 
the Digitalis and Cactus. If the patient becomes very 



TYPHOID FEVER. 53 

weak, the pulse being weak, irregular, or thready, from 20 
to 30 drops of the Aromatic Spirits of ammonia may be 
given, in a sup of water, every two or three hours as the 
urgency of the case demands. 

Where patients are nervous, delirious or stupid, the 
pulse being weak Whiskey or Brandy should be given. It 
may be used in the form of egg-nog, milk-punch or toddy. 
The quantity to be administered must be regulated by its 
effects, however, from six to twelve ounces is usually the 
proper amount to be administered during twenty-four 
hours. 

Where the attack occurs during warm weather the 
patient's bed should be screened in order to prevent flies 
contaminating the food and drink of the attendants. The 
discharges from the kidneys and bowels should be disin- 
fected with boiling water as soon as passed and then 
buried. 

The patient's entire body should be sponged, a limb at 
a time, once a day, with tepid water, wiping perfectly' 
dry, using sufficient friction to produce slight redness of 
the skin. The bedding must be changed once a day; 
and the sick-chamber kept scrupulously clean. Admit 
plenty of fresh air into the sick-room. 

The diet must consist of liquid food, such as milk, 
chicken-tea, beef-tea, beef-essence, rice-water, etc., how- 
ever, fruit juices may be admitted in small quantities, 
provided they have been strained, such as orange; and 
there are no objections to a thoroughly ripe banana when 
stripped of the peel and thoroughly crushed, and beaten 



54 THE PRACTICE OF MEDICINE 

like an egg. Lemonade, strained, may be allowed through- 
out the attack. 

Finally, when convalesence is fully established, put the 
patient on 3 drops of the Fl. Ext. of Nux Vomica and 10 
drops of the Fl. Ext. of Hydrastis Canadensis, thus: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Canadensis, . . . 1 ounce, 
Aromatic Elixir, sufficient to make, . . 6 ounces. 

Mix and give a teaspoonful before each regular meal. 
If the feet or ankles are swollen, add 3 drops of the Fl. 
Ext. of Apocynum Cannabinum to each dose. 

Do not allow solid food until ten days after the disap- 
pearance of fever. 

It is thought the following from the Bulletin of the 
Missouri State Board of Health will be of interest to the 
reader : 

COLD BATHS IN TYPHOID FEVER. 
"There has been for some time a growing distrust of 
the value of the cold-bath treatment in typhoid fever. 
Why this opinion has not prevailed before, the writer cannot 
understand, for there are many practical objections to it. 
Besides, the benefits expected from them are often disap- 
pointing to those who observe the closets in such cases. 
We don't wish to underrate the value of hydriatic measures 
in the management of this disease, for often they are invalu- 
able, but to use the cold bath to the exclusion of all other 
medical treatment is in the writer's opinion unwise. This 
opinion is based upon personal experience, and not upon 
recent literature touching upon this subject. Dr. John 



COLD BATHS IN TYPHOID FEVER. 55 

McRae in American Medicine has recently published an 
article which throws a great deal of light upon the relative 
value of the cold bath and other methods of treatment. 
He gives a review of 717 cases of typhoid fever treated at 
the Montreal General Hospital during a period of five 
years; 439 of these cases received bath treatment, antipyretic 
medical treatment was given to 148 cases and sponging 
to 94 cases. It was supposed that the sponging was given 
to only the mild cases, and they have been excluded from 
this comparison. The method of cold bath was the same 
as that used by Brand. His antipyretic treatment consisted 
of five grains of salol and five grains of phenacetine every 
four hours. The mortality as given by Dr. McRae is as 
follows: With the bath treatment it was 10.9 per cent, 
with the antipyretic treatment it was 9.4 per cent. The 
complications seemed to be more frequent under the bath 
treatment. Haemorrhage complications in these cases was 
12.3 per cent.; 5.5 per cent, suffered from perforation and 
15.2 from delirium. With the antipyretic treatment only 
6 per cent, had haemorrhage, 6.8 per cent, suffered with 
perforation and 14 per cent, with delirium. The author of 
these statistics also reports that neuritis was much more 
frequent after the baths. The series makes no marked 
indication of any form of treatment, save in the bath treat- 
ment there are more cases of haemorrhage and neuritis, 
whereas, in the antipyretic treatment haemorrhage is compar- 
atively infrequent. It is of great practical interest to note 
the apparent value of this simple treatment which he 
styles antipyretic. Five years ago it would have been impos- 



56 THE PRACTICE OF MEDICINE. 

sible to have persuaded the medical profession to believe 
that this simple treatment of typhoid fever would be produc- 
tive of a lower death-rate than the cold-bath treatment, 
but it is observed in medical literature quite often these 
days that it is, and that the Brand method is becoming less 
popular and other methods are considered superior. Of 
course, no very great importance can be placed upon the 
value of what Dr. McRae calls his antipyretic treatment. 
Five grains of phenacetine every four hours is a very slight 
antipyretic. The idea it demonstrates is, that if you leave 
a patient alone he will do better than if he is treated with 
a cold bath. The free use of salol in typhoid fever is by 
far the most rational treatment that has ever been used, 
but Dr.. McRae's method of giving it does not suit the notions 
of the writer. Five grains of this drug every four hours 
will do a little good, but a very little. Fifteen grains every 
four hours is little enough to give in most cases. It is not 
uncommon in this part of the country to give twenty grains 
every three hours. This quantity given in powder has 
an antipyretic effect, besides, its satisfactory effect can at 
once be seen, it flattens the bowels, checks diarrhoea, cleans 
the tongue, lowers the temperature and stops delirium. 
It is unquestionably conservative to state that the mortality 
in typhoid fever-cases with the intelligent use of salol and 
proper feeding and careful nursing ought not to be over 
5 per cent. We have no desire to depreciate the very great 
value of frequent sponging with ordinary water. They 
are often soothing and refreshing, but not so with the cold 
bath. They experience no feeling of relief or pleasure 



YELLOW FEVER. 57 

after or during their use. If we were to devote more time 
and study to each individual case, its wants and needs, 
rather than follow without the slightest variation one method 
of treatment, we would save cases we now lose. Many 
physicians, I believe, overlook the importance of little 
things which have a decided bearing upon the future term- 
ination of their cases. The patient, when it is possible, 
should be humored. He may have diseased notions about 
things, and it may not be possible or wise to please him, 
but when you can comply with all of his wishes you are in 
a position to do the most for him. He may want his room 
darker or lighter, warmer or colder, it may be too crowded 
or too noisy, he may object to the odor of certain flowers 
or disinfectants, his attendants may not understand him, 
he may not appreciate their efforts, and, unless they are 
experts, discord prevails, and a fretted expression is on 
your patient's face. All of these things when combined 
have a very decidedly bad effect in most cases, and might 
be altogether the indirect cause of a man's death. These 
are only a few of the small things I can think of which should 
always be looked after and corrected- in the management 
of typhoid cases." 

YELLOW FEVER. 

YELLOW JACK. 

Yellow fever is an acute, highly infectious, non-contagious 
endemic and epidemic disease consisting of three stages; 
the febrile, the remission, and the collapse; characterized 
by violent fever, yellowness of the surface and "black 
vomit." It is a disease of warm climates, its true home 



58 THE PRACTICE OF MEDICINE. 

being in the tropics; the specific poison or bacillus producing 
it only existing with a high temperature and is destroyed 
by frost. The disease is usually seen during June, July, 
August, September and October. One attack confers 
immunity from a second. 

It is caused by a specific poison or the bacillus icterioides, 
which gains entrance into the system through the bites 
of infected mosquitoes. 

Symptoms: An attack, though frequently preceded 
for one or more days by languor, loss of appetite, headache, 
pain in the back and limbs, is usually ushered in with a chill. 
High fever accompanied by restlessness, flushed face and 
redness of the eyes, follows. The pulse varies in different 
cases; in some it is quick, full and strong; in others, it is 
weak or irregular. The tongue is usually furred, the 
stomach irritable and in a majority of cases there is vomiting. 
Thirst is extreme; and the patient complains of severe 
pains in the head, back, stomach and large joints. As 
the disease advances soreness in the region of the stomach 
becomes a marked symptom. In from one to three days, 
not so long in severe cases, the temperature declines to ioo 
or 101 degrees, and all of the symptoms, except the soreness 
in the region of the stomach, subside and the skin becomes 
moist and frequently covered with perspiration. Convales- 
cence may now occur, but more commonly this stage 
is followed, after from one to twelve hours, by the stage 
of collapse. At this, or an earlier period of the disease, 
yellowness of the skin makes its appearance, becoming 
more marked as the disease advances. 






YELLOW FEVER • 59 

Weakness now becomes great; the pulse is weak and 
thready or weak and irregular; the tongue becomes brown 
or dark; the irritation of the stomach is extreme; and 
we soon have that characteristic symptom known as " black- 
vomit." Haemorrhage may occur from different parts of 
the body, the patient soon becoming insensible. Delirium 
is common, and, in severe cases, there are involuntary 
discharges, convulsions and clammy sweats, death soon 
closing the scene. 

In other cases, there is a reaction, fever coming up, 
which may assume a typhoid type and run about the same 
course as typhoid fever. 

In all cases of yellow fever observe the following instruc- 
tions: Place the patient in bed and do not allow him to 
assume the erect position under any circumstances; screen 
the bed with some material sufficiently fine to prevent 
mosquitoes from gaining access to the patient and thus 
obtaining the infectious germs or material and trans- 
mitting them to the attendants or others; disinfect the dis- 
charges, with boiling water, as soon as they are passed 
and then bury them. Keep the patient, his room and 
bedding, scrupulously clean. Admit an abundance of 
fresh air into the sick chamber and let the diet be light 
but nutritious. 

Treatment: This should be commenced precisely 
as we would the treatment of any other fever. If the 
pulse is full and strong and the stomach not irritated give 
Veratrum. If the face is flushed, and the pupils contracted 
add Gelsemium as follows: 



6o THE PRACTICE OF MEDICINE. 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour or every hour 
and a half as the urgency of the case demands. 

If the fever is high from 3 to 5 grains of Acetanilide 
may also be given every three or four hours. 

If the stomach is irritated, which is usually the case, 
give Aconite, instead of the Veratrum, as follows: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour or every hour 
and a half. 

If the patient is sleeping too much, sleeping with the 
eyes partly open, the pupils being too large, the feet and 
hands cool, give Belladonna instead of the Gelsemium, thus: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour or every hour 
and a half. 

If the pulse is weak and irregular give Digitalis and 
Cactus, and if there are indications of passive congestion 
of the brain add the Belladonna, thus: 

Fl. Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grandiflorus, 24 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 



YELLOW FEVER. 61 

Mix and give a teaspoonful every two hours. 

If particularly indicated at the commencement of the 
attack Calomel may be used, thus: 

Calomel, i grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, i grain. 

Mix and divide into five powders and give one of them 
every hour. Should they fail to act mildly on the bowels 
give Oil, Salts or a Seidlitz Powder. 

If the tongue is broad and pallid, uniformly coated 
with a whitish, pasty coat, give 20 grains of the Sulphite 
of Soda every three or four hours until the tongue becomes 
clean. 

If the urine is scanty give 15 or 20 grains of the Acetate 
of Potash or a half-teaspoonful of the Fl. -Ext of Buchu 
every three or four hours as is necessary to act on the 
kidneys. 

If there is vomiting apply a Mustard-Plaster, or a cloth 
wet with the White Liniment, over the region of the stomach 
and give a Creosote Compound Tablet every hour. 

The following is also highly recommended for vomiting 
in these cases: 

Subnitrate of Bismuth, 1 drachm, 

Hydrochlorate of Cocaine, 3 grains. 

Mix and divide into six powders and give one every 
hour. 

Small lumps of ice are also very beneficial in some cases. 

If these means fail give J of a grain of the Sulphate of 
Morphine hypodermically. 



62 THE PRACTICE OF MEDICINE. 

As soon as yellowness of the skin and eyes makes its 
appearance give the patient a half-teaspoonful of the Fl. 
Ext. of Chionanthus Virginica every four hours until every 
trace of the yellowness disappears. 

When the " black- vomit, " which is dark blood, makes 
its appearance, or where there is haemorrhage from any 
other part of the body, give the Fl. Ext. of Ergot, in from 
15 to 30-drop doses every half-hour or hour as the 
urgency of the case demands. 

During the stage of collapse the extremities should 
be well wrapped with a blanket that has been dipped into 
hot Mustard-Water and then wrung out. Hot rocks, 
bricks, irons, etc., should also be applied to them. 

Half-teaspoonful of the Aromatic Spirits of Ammonia 
may be given every half-hour or hour as the urgency of 
the case demands. If these means fail to bring about a 
^reaction give from 1-24 to 1-16 of a grain of the Sulphate 
of Strychnine, hypodermically, every two or three hours. 
Whiskey may also be used freely in these cases. 

If the system reacts, a secondary fever of a typhoid type 
may follow, which should be treated precisely as you would 
typhoid fever. 

Finally when convalescence is fully established, put the 
patient on the following tonic until the former health is 
regained : 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Canadensis, . . . 1 ounce, 

Fowler's Solution of Arsenic, i| drachms, 

Aromatic Elixir, sufficient to make, . . 6 ounces. 



TYPHUS FEVER 63 

Mix and give a teaspoonful before each regular 
meal. 

TYPHUS FEVER. 

SHIP FEVER, JAIL FEVER, FAMINE FEVER. 

Typhus fever is an acute infectious, highly contagious 
epidemic disease; characterized by sudden invasion, great 
exhaustion, violent delirium and a peculiar eruption, a 
sickening odor, favorable cases terminating by crisis about 
the fifteenth day. 

It is caused by a special infecting germ, which is influenced 
by filth and over crowding. The poison may be transmitted 
by personal contact with the patient or by means of wearing 
apparel, furniture, etc. 

Symptoms: In some cases there are premonitory 
symptoms as weakness, headache and loss of appetite. In 
others the attack begins abruptly with a chill followed by 
violent fever, the temperature reaching 104 to 106 degrees 
or even higher in severe cases. The fever is continuous; 
the pulse full and bounding, the face flushed, the eyes bright 
and the pupils contracted. Delirium soon follows, the 
patient lying in a stupor half asleep much of the time. 
Toward the end of the first week, in most cases, the eruption 
appears all over the chest, abdomen and upper parts of 
the limbs. It has a coarse, red measly appearance, and 
does not disappear upon pressure. A sickening odor 
is usually present at this stage. 

The bowels are constipated as a rule, throughout the 
attack. 



64 THE PRACTICE OF MEDICINE. 

On or before the beginning of the second week of the 
attack the prostration is extreme; twitching of the tendons 
of the wrists is common; the tongue is dry and of a dark- 
red color; the pulse is weak and irregular, and the urine 
scanty and high colored. 

By the end of the second week the fever declines rapidly 
and convalescence is established, however, death may 
occur before the fifth day of the attack. The mortality 
varies in different epidemics from five to thirty-five per cent. 

One attack usually gives immunity for life. 

The most common complications are pneumonia, bron- 
chitis, pleurisy and swelling of the parotid glands. 

Treatment: The treatment may be commenced by 
the administration of Calomel, thus: 

Calomel, i grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, i grain. 

Mix and divide into five powders and give one every 
hour. Should they fail to act on the bowels give Salts, 
Oil or a Seidlitz Powder. 

See that the bowels act each day from the beginning of 
the attack, for this purpose use Oil when necessary. 

Control the fever with sedatives as you would in any 
other disease. 

If the pulse is full and strong give one drop of the Tr. 
of Veratrum or the same amount of the Tr. of Aconite, 
and if the face is flushed, the eyes bright, and the pupils 
contracted, add Gelsemium, thus: 



TYPHUS FEVER 65 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of .Gelsemium 27 drops, 

Water 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half; 
and if the fever is high, in addition to this, give 5 grains 
of Acetanilide every three or four hours. 

If the stomach is irritated Aconite must be used instead 
of the Veratrum, adding the Gelsemium, as follows: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half. 
Where the patient is sleeping too much, the pupils being 
too large Belladonna should be used instead of the Gel- 
semium, add six drops of the fluid extract of it to the 
Aconite mixture. 

If the pulse is weak or irregular give Digitalis and Cactus, 
adding the Belladonna, if indicated; and if the tongue is 
dark-purplish add Baptisia Tinctoria and Echinacea, thus: 

Fl. Ext of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grand., 24 drops, 

Fl. Ext. of Baptisia Tinctoria, 24 drops, 

Fl. Ext. of Echinacea, 6 drachms, 

Water, ; 6 teaspoonfuls. 

Mix and give a teaspoonful every two hours. 
In some cases the tongue is broad and pallid, uniformly 
coated with a filthy, white coat. This condition demands 
20-grain doses of the Sulphite of Soda every three or four 
hours. 



66 THE PRACTICE OF MEDICINE. 

In most cases the tongue is red and dry, sometimes dark 
or almost black. In these cases, 3 drops of the Hydro- 
chloric Acid should be given every three hours. It must 
be largely diluted with water. 

Where there is scantiness of urine give 15 or 20 grains 
of the Acetate of Potash every three or four hours, thus: 

Acetate of Potash, 5 drachms, 

Water, 2 ounces. 

Mix and give a teaspoonful as directed. The Potash 
is incompatible with Hydrochloric Acid, therefore, if the 
patient is taking the latter, Buchu should be used. It 
may be given in 30-drop doses of the Fl. Ext. every three 
or four hours. 

If the pulse becomes very weak, Aromatic Spirits of 
Ammonia and Whiskey may be used freely. 

In cases of great weakness 1-40 of a grain of the Sulphate 
of Strychnine may be given every two or three hours. When 
necessary it may be given hypodermically. 

Concentrated nourishment should be given from the 
beginning of the attack. 

When the fever subsides give the following tonic: 

Fl. Ext, of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make,. .6 ounces. 

Mix and give a teaspoonful before each regular meal 
until the usual strength is regained. 



ERUPTIVE FEVERS. 67 

MOUNTAIN FEVER. 

MOUNTAIN SICKNESS. 

This is a fever developed after ascent to very high 
altitudes; characterized- by quickened pulse, difficult breath- 
ing, dizziness, and headache. 

Its cause is the extreme elevation. 

The " mountain fever" of the older writers is now very 
generally conceded to be typhoid fever. 

Symptoms: These are a rapid pulse, great difficulty 
in breathing, headache, dizziness, and, sometimes, nausea 
and vomiting with slight fever, the temperature rarely 
reaching more than 10 1 degrees. A general indisposition 
and a sense of exhaustion are experienced upon exertion 
of any kind. Haemorrhage from the lungs sometimes 
occurs, though rarely. 

Treatment : Require the patient to assume the recum- 
bent position and administer a dose of Salts or a Seidlitz 
Powder. 

Control the fever as you would in any other disease. 
If the pulse is full and strong give Veratrum or Aconite 
and if indicated add Gelsemium or Belladonna. If the 
pulse is weak give Digitalis and Cactus adding Belladonna 
if indicated. 

ERUPTIVE FEVERS. 

Each of the eruptive fevers is characterized by an 
eruption peculiar to itself and by which it may be distin- 
guished from others of the same class. 



68 THE PRACTICE OF MEDICINE. 

SCARLATINA. 

SCARLET FEVER. 

Scarlet fever is an acute infectious, contagious disease, 
usually of childhood; characterized by sore throat, high 
fever, rapid pulse, a peculiar scarlet eruption, followed 
by a scaling off of the outer skin and frequently an inflam- 
mation of the kidneys. 

It is caused by a specific poison, probably the diplococcus 
scarlatinae. The disease is contagious from person to 
person and may be conveyed by clothing, books, toys, or 
other articles. 

It may also be conveyed by the air though not for any 
great distance. It is a disease of childhood, few persons 
ever having it after the age of twenty. Unlike measles, 
the older the patient the milder the disease. It sometimes 
occurs as an epidemic. One attack usually confers immu- 
nity from the disease. 

The disease is divided into three types; Scarlatina 
Simplex, Scarlatina Anginosa, and Scarlatina Maligna. 

Symptoms : In from one to eight days, more commonly 
two to four, after exposure, the attack is ushered in with 
a chill, vomiting and, in young children, convulsions. 
High fever follows, the temperature reaching 104 or 105 
degrees. The pulse is full, quick and hard, ranging from 
120 to 150. The tongue has a strawberry-like appearance, 
caused by the projections of red elevations through a 
whitish fur, but later becomes red. 

In from twenty-four to thirty-six hours a bright scarlet 
rash appears, first on the neck and chest, soon spreading 



SCARLATINA. 69 

over the entire body. Patches of the eruption, in various 
parts of the body, appear darker than that surrounding it. 
If the eruption be closely examined it will be found to consist 
of an infinite number of small, red points the rose colored 
ground being simply the base upon which they stand. 
Upon examination of the throat, about the time the eruption 
appears, it will be found red, inflamed and painful. There 
is difficulty in swallowing and the patient complains of 
burning heat of the surface of the body. 

There is severe headache and in many cases diarrhoea. 

About the fourth or fifth day the fever gradually declines; 
the eruption fades and on the sixth or eight day desqua- 
mation (a peeling off of the outer or scarf skin) begins 
continuing from ten days to two or three weeks. The 
patient is pale and emaciated and gains strength very 
slowly. 

In Scarlatina Anginosa, in addition to the foregoing 
symptoms, there is great inflammation and swelling of the 
throat, tonsils and surrounding glands, which causes 
difficulty in breathing and swallowing. 

In Scarlatina Maligna, there is delirium, convulsions, 
twitching of the muscles, the pulse weak, rapid, and irregular; 
and the eruption is delayed and occurs in patches and is 
purplish in color. The temperature is exceedingly high, 
ranging from 107 to no degrees. 

Scarlet fever is very liable to be followed by abscesses 
about the neck and throat; inflammation of the middle 
ear; suppurative inflammation of one or more of the 



yo THE PRACTICE OF MEDICINE. 

joints; and an acute inflammation of the kidneys result- 
ing in dropsy. 

The death-rate ranges from 5 to 10 per cent, in mild 
epidemics to 20 to 30 per cent, in the very severe. The 
younger the .child the greater the danger. 

Treatment: Control the fever. If the pulse is full 
and strong give Aconite or Veratrum and if there is flushed 
face, bright eyes and contracted pupils add Gelsemium, thus : 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour or every hour 
and a half. If there is an inflamed condition of the 
throat, tonsils or other glands of the neck, Phytolacca 
Decandra should be added to the Veratrum, thus: 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, • 27 drops, 

Fl. Ext. of Phytolacca Decandra,. ..18 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour or every hour 
and a half. 

If the stomach is irritated use Aconite instead of the 
Veratrum, adding the Gelsemium and Phytolacca. If 
indicated or if the patient is sleeping more than natural, 
the pupils being too large, use Belladonna instead of the 
Gelsemium, thus: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Fl. Ext. of Phytolacca Decandra,. . . 18 drops. 



SCARLATINA. 71 

Mix and give a teaspoonful every hour or every hour 
and a half. 

Where the fever is high, the skin hot and dry and no 
dilatation of the pupils 5 grains of Acetanilide may be 
given every three or four hours. 

If the bowels are constipated and it is particularly 
indicated the following may be used: 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, 1 grain. 

Mix and divide into five powders and give one every 
hour. Should they fail to act on the bowels give Oil, 
Salts or a Seidlitz Powder. 

If the pulse is weak or irregular give Digitalis and 
Cactus, adding Belladonna if the patient is sleeping more 
than natural, the pupils being too large ; and if the tongue 
and mucous membrane are dark-red or purple add 
Echinacea and Baptisia, thus: 

Fl. Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grandiflorus, 24 drops, 

Fl. Ext. of Baptisia Tinctoria, 24 drops, 

Fl. Ext. of Echinacea, 6 drachms, 

Water, 6 teaspoonfuls. 

Mix and give a teaspoonful every two hours. 
Where the patient is having convulsions give the 
indicated sedative (fever drops) every half-hour until three 
or four doses are taken. Keep the head cool. Pour cold 
water on it, if necessary, to accomplish this. If the feet 
are cold bathe them in warm water, then wrap them with 



72 THE PRACTICE OF MEDICINE. 

a blanket and apply heat to them. Should these means 
fail give Chloral Hydrate every half -hour until relieved. 
The dose of it is one grain for each year of age up to 
twenty. 

If there is scantiness of urine give the following: 

Acetate* of Potash, 5 drachms, 

Water, to make, 2 ounces. 

Mix and give a teaspoonful, in a sup of water, every 
three or four hours. The Fl. Ext. of Buchu, in 30-drop 
doses also answers a good purpose in these cases. 

If the tongue is broad and pallid, the coating consisting 
of a dirty, whitish material, give 20 grains of the Sulphite 
of Soda every four hours until the tongue becomes clean. 
Where the tongue and mucous membrane are too red, 
or red and dry, give 3 drops of Hydrochloric Acid, in a 
third of a glass of water, every three or four hours until 
the tongue assumes its natural color. 

When the eruption appears much relief may be afforded 
the patient by the following: 

Carbolic Acid, 10 drops, 

Vaseline, 2 ounces. 

Mix and anoint the entire body, except the head, with 
it twice a day. 

To overcome the inflammation of the throat use the 
following : 

Peroxide of Hydrogen, 3 ounces, 

Water, 3 ounces. 

Mix and apply to the throat, with an Atomizer, every 
hour or so. 



SCARLATINA. 73 

The following may also be used in these cases: 

Tr. of Iodine, ' 2 drachms, 

Glycerine, 4 drachms, 

Carbolic Acid, \ drachm, 

Simple Syrup, sufficient to make, . . 2 ounces. 
Mix and use with a soft mop every three hours 
In severe cases use the following: 

Tr. of Muriate of Iron, 3 drachms, 

Glycerine, ; 5 drachms. 

Mix and use with a soft mop every three or four 
hours. 

Where the middle ear is inflamed it will be necessary 
to puncture the drum membrane, after which Powd. 
Boracic Acid should be blown into the ear with a powder 
blower or a quill. 

Should dropsy occur give Digitalis and Apocynum, 
thus: 

Fl. Ext. of Digitails, \ drachm, 

Fl. Ext. of Apocynum Cannabinum, 1 \ drachms, 
Aromatic Elixir, sufficient to make,. .4 ounces. 
Mix and give a teaspoonful four times a day. 
Where patients are slow in regaining their former 
health, give the following tonic: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make, .6 ounces. 
Mix and give a teaspoonful three times a day before 
meals until the former strength is regained. 



74 THE PRACTICE OF MEDICINE. 

RUBEOLA. 

MEASLES. 

Measles is an acute, contagious and epidemic disease; 
characterized by cough, fever and a dusky-red eruption, 
which terminates by desquamation. 

It is caused by a specific poison, which is communicated 
by contact. One attack usually protects from a second 
though there are many exceptions to this rule. All ages 
are subject to it. 

Symptoms : From seven to fourteen days after exposure 
to its contagion there is a light chill followed by fever, 
quickened pulse, slightly furred tongue and in some cases 
vomiting. The early symptoms are those of a severe cold, 
such as increased secretion from the nose, cough, hoarseness 
and red watery eyes. There is usually pain in the head, 
back and limbs. 

About the fourth day, sometimes sooner, the eruption 
makes its appearance, first, on the face, neck and breast, 
but soon extending to the rest of the body. By the fifth 
or sixth day the eruption reaches its height and begins to 
fade; first, on the face and neck, then, on the body and 
limbs. About this time or earlier, the fever subsides and 
there is soon a desquamation (or scaling off), but the cough 
may continue for some time. 

In severe cases the fever is high, the eruption slow, 
sometimes ten or twelve days in making its appearance. 

The most common complications are tonsillitis and 
pneumonia. It may be followed by scrofula or pulmonary 
tuberculosis, especially in those of a strumous diathesis. 



RUBEOLA. 75 

Treatment: This should be commenced by the 
administration of the proper sedative (" fever-drops"). 
If the pulse is full and strong give Veratrum or Aconite 
and if there is flushed face, bright eyes and contracted 
pupils add Gelsemium, and if there is dry cough add Tr. 
of Lobelia, as follows : 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Tr. of Lobelia, 54 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half while 
there is fever.. 

Where the stomach is irritated use Aconite instead of 
the Veratrum, adding the Lobelia; and if the patient is 
drowsy, the pupils being too large, add Belladonna instead 
of the Gelsemium, thus : 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, , 6 drops, 

Tr. of Lobelia, : 54 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half while 
there is fever. 

Keep the head cool and the feet warm. If there is a 
broad, pallid tongue, coated with a dirty, whitish coat, 
give 20 grains of the Sulphite of Soda every four hours 
until the tongue becomes clean or changes its color. 

If the tongue is too red give 3 drops of Hydrochloric 
Acid, in a sup of water, every four hours until the tongue 
assumes its natural color. 



76 THE PRACTICE OF MEDICINE. 

If the bowels are constipated give Oil, Salts or a Seidlitz 
Powder. 

If the urine is scanty give 20 grains of the Acetate of 
Potash, or 30 drops of the Fl. Ext. of Buchu every four hours. 

Should diarrhea occur control it with the following: 

Subnitrate of Bismuth, 30 grains, 

Powd. Myrica Crifera, 30 grains, 

Sulphocarbolate of Zinc, 18 grains. 

Mix and divide into six powders and give one of them 
every three or four hours as is necessary to check the 
bowels. 

Give the patient plenty of cold water. 

If the disease is complicated with tonsillitis or pneu- 
monia treat it as such. 

(See Tonsillitis, also Pneumonia.; 

ROTHELN. 

GERMAN MEASLES. 

An acute contagious disease; characterized by slight 
fever, sore^ throat, enlargement of the glands of the neck 
and a rose-colored eruption. 

It is propagated by contagion and is probably of microbic 
origin, though, its specific organism has not been isolated. 
One attack usually confers immunity against subsequent 
attacks. It may occur epidemically or sporadically. 

Symptoms: Usually from three to twelve days after 
exposure to its contagion the disease commences with slight 
fever, followed by soreness of the throat, dry cough, enlarge- 
ment of the glands of the neck and in from one to three 
days the appearance of the eruption, which may be accom- 






VARIOLA. J7 

panied with a rise in the temperature to 103 degrees. In 
mild cases the first * symptom noticed may be the rash, 
which first appears on the face and extends downwards 
over the body. It consists of slightly elevated, rose-col- 
ored spots, the size of a pin-head, which coalesce, forming 
patches. Within the first week the disease gradually sub- 
sides, the eruption fades, there is a slight desquamation 
and- convalescence is fully established. 

Treatment: Control the fever with sedatives ("fever- 
drops") as you would in any other disease; and if the 
bowels are constipated give Oil, Salts or a Seidlitz Powder. 

The diet should consist of such articles as teas and soups. 

VARIOLA. 

SMALL-POX. 

Small-pox is an acute, epidemic and highly contagious 
disease; characterized by severe chill, fever, intolerable 
pain in the head, back and limbs, followed by an eruption 
and a secondary fever. 

It is caused by a specific poison, the nature of which is 
unknown, no specific germ having been fully demonstrated. 

It is communicated by personal contact, clothing, etc. 
There is no time from the initial chill until the final desqua- 
mation when it is not contagious; though, the stage of 
suppuration is the most virulent. 

"One attack, as a rule, protects from a second, though, 
even third attacks in the same individual occur." — Loomis. 

It was brought to the United States from Europe in 
1649 and gained its first foothold in Boston, Mass. 



7$ THE PRACTICE OF MEDICINE. 

The disease is divided into three types; Discreet, Con- 
fluent and Malignant. 

Symptoms : From ten to fourteen days after exposure 
to the contagion the patient has a violent chill, lasting one, 
two or three hours, followed by fever, severe pain in the 
head, back and limbs. The pulse is full, strong and rapid; 
the tongue furred; and, in many cases, there is vomiting. 
At this . time, adults are not infrequently delirious and 
children may have convulsions. At the end of the third 
day from the initial chill the characteristic eruption makes 
its appearance; first, on the forehead and lips, then, on the 
neck, arms, trunk and lower extremities. The eruption 
first consists of small red pimples resembling flea bites. 
These increase in size until about the eight day, first contain- 
ing a watery fluid, afterwards changing to a yellow matter. 
The eruption is grouped together in threes or fives, each 
one being surrounded by a red band. As the disease 
advances they become depressed in the center, but as their 
contents become purulent they assume a conical shape. 
The face becomes swollen, and, by the eleventh day of the 
disease, pus oozes from the pustules, and drying forms 
scabs, which drop off from the seventeenth to the twentieth 
day of the attack, leaving red pits which soon become 
white. 

When suppuration is fully established there arises a 
secondary fever of longer or shorter duration and at this 
stage of the disease the patient has an offensive odor, 
which is characteristic. 



VARIOLA. 79 

In the confluent form of the disease, the symptoms 
are all worse, the eruption being thicker, forming, when 
suppuration occurs, almost a solid scab or shield. 

In malignant small-pox all the symptoms are more 
aggravated and frequently patients die before the eruption 
makes its appearance. 

During the secondary fever of small-pox there is liable 
to be severe complications, such as pneumonia, pleurisy 
and flux. 

Varioloid: Is small-pox modified by vaccination. 
The symptoms of it are the same as the first named only 
it is very much milder, the eruption being very slight. 

Treatment : Small-pox is a self -limited disease, there- 
fore it is useless to try to abort an attack, but that it can 
be greatly modified there is no doubt. Where one has had 
an opportunity to contract the disease he should, at once, 
commence living on light diet, abandoning grease and 
meats; and keep his bowels slightly open with Sulphur. 

Finally when the disease makes its appearance, and 
fever comes up, give sedatives according to indications. 
Where the pulse is full and strong give Veratrum or 
Aconite, and if the patient is restless, the face flushed and 
the pupils contracted, add, Gelsemium, thus: 

Tr. Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour or every hour 
and a half while there is fever. 



80 THE PRACTICE OF MEDICINE. 

If the stomach is irritated give Aconite instead of the 
Veratrum, adding the Gelsemium, if indicated, as in the 
foregoing; or if the patient is sleeping too much the pupils 
being too large add Belladonna, thus: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half. 
If the fever is high and the pupils not dilated give 5 
grains of Acetanilide every three or four hours. 

If the pulse is weak or irregular give Digitalis and 
Cactus, adding the Belladonna if indicated, as follows: 

Fl. Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grandiflorus, 24 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every two hours. 
Where the tongue and mucous membrane has a dusky- 
red, or purplish appearance, Baptisia and Echinacea should 
be given. They may be added to the Digitalis and Cactus, 
thus: 

Fl. Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grandiflorus, 24 drop, 

Fl. Ext. of Baptisia Tinctoria, :24 drops, 

Fl. Ext. of Echinacea, 6 drachms, 

Water, 9 teaspoonfuls. 

Mix and give a teaspoonful every two hours. At the 
same time, the patient should take 3 drops of Hydrochloric 



VARIOLA. 81 

Acid, in a sup of water, every four hours until the tongue 
assumes its natural color. 

In some cases the tongue is broad and pallid, the coating 
consisting of a dirty, whitish, pasty material. This condition 
calls for the Sulphite of Soda. It may be given in 20-grain 
doses every four hours until the tongue becomes clean and 
assumes its natural color. 

If the patient complains of general muscular soreness 
6 drops of the Fl. Ext. of Cimicifuga may be given every 
four hours until the soreness is relieved. 

Where patients complain of severe pain 10 grains of 
the Hydrate of Chloral may be given every half-hour until 
the pain is relieved to some extent. By adding the Tr. 
or Essence of Mint to the Chloral its taste may be 
disguised. 

Keep the bowels slightly open throughout the attack. 
This may be accomplished by the administration of Oil, 
Salts or Seidlitz Powders occasionally as the case 
demands. 

Where the tongue has a yellowish coating Calomel 
should be given, thus: 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, 1 grain. 

Mix and divide into five powders and give one every 
hour. If they do not act mildly on the bowels give Oil, 
Salts or a Seidlitz Powder. 

Where the urine is scanty give 20 grains of the Acetate 
of Potash, or ,30 drops of the Fl. Ext. of Buchu, every four 



82 THE PRACTICE OF MEDICINE. 

hours until it acts on the kidneys, then, continue its use 
sufficiently often to keep up its effects. 

Keep the room dark but let the patient have plenty 
of fresh air. Remove all clothing, carpets, and bedding, 
from the room except that which is actually necessary for 
the comfort of the patient. 

Keep the patient clean. Castile soap and water rightly 
used will accomplish this. Sprinkle Carbolic Acid over 
the room once or twice a day. Chloride of Lime kept 
in the room, in an open vessel, is also a good dis- 
infectant. 

If at any time the stomach becomes irritated give a 
Creosote Compound Tablet every hour. The following 
also answers an excellent purpose in these cases: 

Subnitrate of Bismuth, i drachm, 

Hydrochlorate of Cocaine, 3 grains. 

Mix and divide into six powders and give one every 
hour until the stomach is relieved. At the same time a 
Mustard-Plaster may be applied over the region of the 
stomach. 

Where convulsions occur, they should be controlled 
with the indicated " fever-drops, " cold applications to the 
head, and if necessary, hot applications to the feet and the 
administration of the Hydrate of Chloral. 

If the eruption appears in the mouth or throat let the 
patient hold small lumps of ice in the mouth and also wash 
the mouth and throat frequently with the following: 

Chlorate of Potash 2 drachms, 



VACCINATION. 83 

Carbolic Acid, \ drachm, 

Water, 6 ounces. 

Mix. 

In order to prevent pitting, which is very important, 
as soon as the pustules begin to discharge pus commence 
the use of the following: 

Ichthyol, 2 drachms, 

Olive Oil, 4 ounces. 

Mix and apply with a feather sufficiently often to prevent 
the remedy's becoming dry on the face. At the same time 
cover the face with black, oiled silk, which has had holes 
cut in it for the nose and mouth, and do not remove it from 
the face only when it is necessary to apply the Ichthyol 
and Oil. Continue to keep the room dark, allowing no 
light except that of a lamp or a candle. 

After the secondary fever makes its appearance it will 
be necessary to support the patient's strength. For this 
purpose beef-tea, mutton-broth, chicken-tea, oysters, eggs 
and milk may be given. Where patients are very weak, 
Whiskey and Aromatic Spirits of Ammonia should be used 
freely. 

Before allowing the patient to mingle with the outside 
world he should be given a thorough bath and be dressed, 
from head to foot, with clean clothing. 

VACCINATION. 

This is an inoculation with vaccine matter or cow-pox, 
bovine virus. Persons, who are properly vaccinated are, 
as a rule, protected from small-pox, especially severe or 
fatal attacks. Every person should be vaccinated at 



84 THE PRACTICE OF MEDICINE. 

least twice; first in infancy, and then, at twelve or sixteen 
years of age, although to be vaccinated each time the disease 
makes its appearance in the community would be a better 
plan. 

To properly vaccinate a patient, scrape the skin until 
it is ready to bleed, then, apply the virus, which is previously 
moistened with water. 

Another method is to make four or five horizontal, and 
as many transverse, cuts, applying the virus as in the method 
previously mentioned. To be successful very slight bleeding, 
if any, should occur. 

The wound should be dressed with absorbent cotton 
held in place by adhesive strips. 

About three days after the virus is applied, if it "takes," 
a papule appears and by the sixth day a vesicle, depressed 
in the center, has formed and by the eight day a fully 
developed pustule, surrounded by a red areola, has formed ; 
and by the fourteenth day a brown scab, which falls off 
by the twenty- third day, has formed. 

Fever sometimes occurs during the course of vaccina- 
tion. 

It may be controlled with sedatives and laxatives. 

VARICELLA. 

CHICKEN-POX. 

Varicella is an acute, contagious, febrile disease; char- 
acterized by slight fever and an eruption of vesicles on the 
skin. 

It is a disease of childhood, rarely seen in adults, occuring 
as an epidemic, but sporadic cases of it occur. It may be 



ERYSIPELAS. 85 

contracted by personal contact with one afflicted with it. 
As in small-pox, no specific germ has been satisfactorily 
isolated. One attack usually protects from a second. 

Symptoms : From fourteen to sixteen days after expos- 
ure to its contagion, slight fever, which may or may not 
be preceded by a chill or chilliness, occurs. There is a 
quickened pulse, loss of appetite, slightly furred tongue 
and more or less constipation of the bowels. The fever 
continues for twenty-four hours, when the eruption 
makes its appearance. It first appears on the body, 
rarely on the forehead and face. It first appears as 
slightly reddened and elevated pimples, which soon form 
vesicles (blisters) containing a clear fluid. These vesicles 
soon break, forming scabs, which, in the course of three 
to five days, fall off. A new crop frequently forms 
about the time, or after, the first is matured. About the 
time the vesicles are fully formed the skin appears as if 
it had been sprinkled with boiling water. 

Treatment: Control the fever as you would in any 
other disease. If the bowels are constipated administer 
Salts or Oil. If there is considerable irritation of the skin 
use the following: 

Ichthyol, 1 drachm, 

Olive Oil, 2 ounces. 

Mix and apply every two or three hours with a feather. 

ERYSIPELAS. 

st. Anthony's fire. 
Erysipelas is an acute, specific, infectious, febrile disease; 
characterized by a more or less circumscribed inflammation 



86 THE PRACTICE OF MEDICINE. 

of the skin and subcutaneous tissue, high fever and moderate 
prostration. 

The specific agent of the disease is the streptococcus 
erysipelatis of Fehleisen. 

Erysipelas will not develop on a surface that does not 
present a break. This may be so trivial that it entirely 
escaped notice. Women, who have been recently delivered 
and those subjected to surgical operations are peculiarly 
liable to the disease. 

The disease may be transmitted by clothing, surgical 
instruments and unclean hands. Physicians, or others, 
who have recently handled patients with erysipelas, should 
not, under any circumstances, attend or visit a woman 
during or for some days after her confinement. One attack 
predisposes to another. 

Symptoms: The first symptom noticed may be the 
inflammation of the skin, though more commonly an 
attack commences with a chill, or chilliness, which is 
followed by fever, quickened pulse, headache, furred 
tongue, constipated bowels and in many cases vomiting. 

There is a burning sensation of the skin, where the 
eruption afterwards makes its appearance, and small red 
spots are soon seen and these increase in size until they 
coalesce. The skin soon becomes red and swollen, and 
there is a peculiar, burning, tingling, sensation in the part, 
which is very painful. 

When the disease attacks the face and more especially 
when the eyelids are involved there is great swelling; and 
when the eruption is on the scalp there is, sometimes, 



ERYSIPELAS. 87 

delirium. If the covering of the brain is involved there is 
convulsions, which may end in death. It may leave one 
part of the body and attack another, or it may extend over 
the entire body, although either of these results is of rare 
occurrence. There are, in some cases, blisters containing 
a clear watery fluid formed on the inflamed surface, and 
these break leaving a brownish surface. In the course of 
six or eight days the eruption begins to fade, leaving a 
rough wrinkled surface, which finally desquamates. 

The throat is sometimes involved. In these cases, 
there is great danger from the swelling, which interferes 
with breathing. 

Where erysipelas attacks a wound we have the same 
symptoms as in the so-called idiopathic variety of the disease 
except the attack is more severe. 

The fever sometimes assumes a low typhoid or continued 
type. In these cases the tongue is of a dark-red or purplish 
color, sordes appear on the lips and teeth and diarrhoea 
follows. The disease is not infrequently complicated 
with pneumonia, pleurisy and meningitis. 

Treatment: Control the fever with Aconite or Vera- 
trum as you would in any other disease. If the patient is 
restless, the pupils being too small, add Gelsemium, or 
if the patient is drowsy, sleeping too much, the pupils 
being too large, use Belladonna instead of the Gel- 
semium. 

If the fever is high, the skin' dry and the pupils not 
dilated give 5 grains of Acetanilide every four hours. 



88 THE PRACTICE OF MEDICINE. 

If there is a yellowish coating on the tongue give the 
following : 

Calomel, i grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, i grain. 

Mix and divide into five powders and give one of them 
every hour. Should they fail to act on the bowels give 
Oil, Salts or a Seidlitz Powder. If preferred one or two 
Improved Compound Cathartic Pills may be used instead 
of the Calomel. 

Give 20 drops of the Tr. of Muriate of Iron, every 
three or four hours after the cathartic has acted. It should 
be given largely diluted with water and through a quill 
in order to preserve the teeth. 

As a local application the following is excellent : 

Oil of Cade (Younkin's), 2 ounces, 

Olive Oil, 2 ounces. 

Mix and apply with a feather every two or three 
hours. 

The following is also first class : 

Gum Camphor, 1 ounce, 

Carbolic Acid, 1 ounce, 

Alcohol, . . . J ounce, 

Glycerine, \ ounce, 

Olive Oil, 3 ounces. 

Mix and apply with a feather every three hours. 
If the fever is of a remittent type use Quinine as 
directed in remittent fever. 



ERYSIPELAS. 89 

If there is scantiness of urine give 30 drops of the Fl. 
Ext, of Buchu every three hours until it acts on the 
kidneys. 

Where a wound is complicated with erysipelas it should 
be thoroughly cleansed with Peroxide of Hydrogen, after 
which it should be washed with a' 1-4000 solution of 
Bichloride of Mercury and then dressed with the Camphor 
and Carbolic Acid preparation previously recommended 
as a local application. The wound should be dressed 
sufficiently often to insure cleanliness. 

Should convulsions occur give the " fever-drops " 
every half-hour until four or five doses are taken; 
keep the head cool and the feet warm and give 10 grains 
of Chloral every half- hour until relieved. 

Where the fever assumes a typhoid type, the pulse being 
weak or irregular Digitalis and Cactus should be given; 
and if the tongue or mucous membrane are dusky or 
dark purplish, Baptisia and Echinacea should be added 
as follows : 

Fl. Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grandiflorus, ...24 drops, 

Fl. Ext. of Baptisia Tinctoria, 24 drops, 

Fl. Ext. of Echinacea, 3 drachms, 

Water, 9 teaspoonfuls. 

Mix and give a teaspoonful every two hours. If 
the pulse is very weak 1-40 to 1-30 of a grain of the 
Sulphate of Strychnine may also be given every three or 
four hours. Whiskey should also be given rather freely 
in these cases. The proper amount of it is from 8 to 12 



90 THE PRACTICE OF MEDICINE. 

ounces during each twenty-four hours. It would prob- 
ably be best to give it in the form of Milk-punch or 
Egg-nogg. 

Where patients are unable to sleep give Chloral, thus: 

Hydrate of Chloral, 2 \ drachms, 

Tr. of Peppermint, 15 drops, 

Water, 2 ounces. 

Mix and give a teaspoonful every half-hour, in a sup of 
water, until the desired effects are obtained or until four 
doses are taken. 

If abscesses form empty them by free incisions and 
wash out their cavities with Peroxide of Hydrogen and 
dress with the dressing recommended for wounds. 

See that the bowels act at least once or twice a day 
throughout the attack. 

The patient's diet should be nutritious but • easy to 
digest. 

When convalescence is established put the patient on 
the following tonic : 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Canadensis, . . . 1 ounce, 
Aromatic Elixir, sufficient to make, .6 ounces. 
Mix and give a teaspoonful before each regular meal. 

DENGUE. 

BREAK-BONE FEVER. 

Dengue is an acute, infectious, epidemic disease of 
tropical and sub-tropical regions; characterized by sudden 
onset, high fever, intense headache, severe pain in the joints 
and muscles and an eruption followed by a remission, 



DENGUE. 91 

a second paroxysm and an eruption differing from the first 
one. Most observers regard the disease as contagious. 
Patients have been known to have as many as three attacks 
during the same epidemic. 

The cause of it is unknown, however McLaughlin, 
of Texas, claims to have isolated its specific micrococcus. 

Symptoms: An attack commences suddenly with a 
chill, followed by high fever, intense headache, severe pain 
and swelling of the joints, soreness and stiffness of the 
muscles. The pulse is rapid, the tongue furred, and the 
bowels constipated; and there may be vomiting. The 
rash, which resembles that of scarlet fever, soon appears. 
In the course of from a few hours to two or three days the 
fever subsides, but the pain and soreness does not entirely 
disappear. 

In from one to three days the fever and pain return but 
not so severe as in the first paroxysm, although the patient 
is considerably debilitated. From the fifth to the seventh 
day, from the beginning of the attack, the second eruption 
makes its appearance and is attended by intense itching. 
After one or two days desquamation occurs and the patient 
slowly recovers. Relapses are not uncommon. 

Treatment: Control the fever as you would in any 
other disease. If the pulse is full and strong give Veratrum 
or Aconite; and if there is flushed face, bright eyes, and 
contracted pupils, add Gelsemium, and where there is 
muscular soreness Cimicifuga should also be added, thus: 

Tr.. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 



92 THE PRACTICE OF MEDICINE. 

FL Ext. of Cimicifuga, 36 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half. If 
the stomach is irritated give Aconite instead of the Vera- 
trum, and if the pupils are too large, Belladonna should be 
used, thus: 

Tr. of Aconite Root, 18 drops, 

FL Ext. of Belladonna, 6 drops, 

Fl. Ext. of Cimicifuga, 36 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half. 
If the bowels are constipated give Oil, Salts or a Seidlitz 
Powder, or, if particularly indicated, give the following: 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, 1 grain. 

Mix and divide into five powders and give one every 
hour. 

If the urine is scanty give 15 grains of the Acetate of 
Potash every three or four hours. 

For the pain in the joints give 10 grains of the Salicylate 
of Soda, made from the Oil of Winter-Green, every three 
hours until it relieves the pain in the joints or until the pain 
in the head becomes more severe. Where the pain is un- 
bearable J of a grain of the Sulphate of Morphine, or 10 
grains of Dover's Powder, may be given and repeated as 
its effects pass off. 

When convalescence is established the following tonic 
should be given: 



PAROTITIS. 93 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Canadensis, 1 ounce, 

Aromatic Elixir, sufficient to make, . . 6 ounces. 
Mix and give a teaspoonful before each regular meal. 

PAROTITIS. 

MUMPS. 

A specific, infectious inflammation of the parotid and, 
sometimes, other salivary glands, with a tendency to migrate 
into the breasts of females and the testicles of males; 
characterized by fever, dryness of the mouth, pain and 
swelling of the glands involved. One attack usually gives 
immunity for life. 

It is propagated by contagion. It is believed to be of 
microbic origin but the specific organism has not been 
isolated. 

Symptoms: From ten to twenty days after exposure 
to its contagion the patient has a chill, which is followed 
by fever, quickened pulse, headache, furred tongue, dry 
skin and constipated bowels. In many cases the chill is 
absent and the fever very slight. The glands soon swell 
and become painful, the jaws stiff, the mouth dry; and the 
tasting of sour substances at this time produces more or 
less pain. The fever and swelling subside and by the end 
of the first week the patient is convalescent, or the breasts 
or ovaries of females, and the testicles of males, become 
affected and the case is protracted. 

Where the testicles are involved there is great swelling 
and the pain is exceedingly severe. This condition lasts 
a variable length of time and may be followed by atrophy 



94 THE PRACTICE OF MEDICINE. 

of the testicles. The disease may be followed, though very 
rarely, by an inflammation of the middle-ear. 

Treatment: This should be commenced by the 
administration of Oil, Salts or a Seidlitz Powder and the 
proper sedative with the addition of Phytolacca Decandra 
(Poke Root). 

If there is fever with a quick, full pulse, give Veratrum 
or Aconite and if there is flushed face, bright eyes and 
contracted pupils add Gelsemium, thus: 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Fl. Ext. of Phytolacca Decandra,. . .18 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half 
while there is fever. 

If the stomach is irritated use Aconite instead of the 
Veratrum; and if indicated, add the Gelsemium; or if the 
patient is sleeping too much, the pupils being too large, 
add Belladonna, thus: 

Tr. of Aconite Root, 18 drops, 

FL Ext. of Belladonna, 6 drops, 

Fl. Ext. of Phytolacca Decandra,. . .18 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half while 
there is fever. 

Where the fever is mild the Aconite and Phytolacca 
are the only remedies that are required. They may be 
administered every one, two, or three hours as the urgency 
of the case demands. 



EPIDEMIC CEREBROSPINAL MENINGITIS. 95 

The swollen part, and the breasts when affected, 
should be bathed with the following: 

Tr. of Veratrum Viride, 5 J drachms, 

Tr. of Arnica, 5 J drachms, 

Fl.Ext of Phytolacca Decandra, 53 drachms. 

Mix and apply with a feather every three hours; and, 
at the same time, take Phytolacca internally. Hot appli- 
cations may also be used. If the testicles are involved 
the patient must wear a suspensory bandage. Where 
pain is very severe J-grain doses of Morphine may be used 
for its relief. 

EPIDEMIC CEREBRO-SPINAL MENINGITIS. 

SPOTTED FEVER. 

A malignant, infectious, epidemic disease; character- 
ized anatomically, by an inflammation of the membranes 
(meninges) covering the brain and spinal cord, and, clin- 
ically, by intense headache, pain in the back and upper part 
of the spine with painful contractions of the muscles of the 
back of the neck, retraction of the head, delirium, stupor, 
coma and frequently the appearance of purpuric spots. 
It occurs more frequently during the winter months and has 
a predilection for the young. It usually occurs as an epi- 
demic but sporadic cases of it are seen. 

The disease is one of the most fatal that we are called 
on to treat; from fifty to seventy-five per cent, or more, of 
those attacked die, death usually occurring in three or 
four hours to as many days. During an epidemic through 
which the writer passed patients were frequently found 



96 THE PRACTICE OF MEDICINE. 

dead or dying upon his first visit to them. It is not con- 
tagious. 

It is caused by the diplococcus meningitidis. Bad 
hygienic surroundings seem to predispose to it. 

Symptoms: In young children an attack may be 
ushered in with convulsions, but in others it usually com- 
mences with a chill, which is often severe. Moderate fever, 
quickened pulse, intense pain in the head extending to the 
back of the neck and spine, and frequently vomiting soon 
follow. There are painful contractions of the muscles 
of the neck and spine; the head is drawn backward and 
movements of the body increase the pain. The patient 
soon becomes delirious, in some cases passes into a stupor 
or deep coma from which it is difficult, or impossible, to 
arouse him. 

The bowels usually remain natural or are constipated 
throughout the attack, and the kidneys usually act less 
than normal. 

The fever may rise to 104 or 105 degrees, but soon drops 
to 102 or 103 where, with slight variations, it remains, 
except in fatal cases it may run as high as 108 or no degrees 
just previous to death. Young children may have convul- 
sions, which, as a rule, do not appear in adults. Dizziness 
is nearly always present, and there is a dread of light and 
noise, and a morbid sensitiveness of the entire surface 
of the body. 

Severe (tonic) spasms of the arms and legs are common. 

The pupils may be contracted, dilated, or unequal 
or they may remain normal, but this is uncommon. 



EPIDEMIC CEREBROSPINAL MENINGITIS. 97 

Loss of sight and hearing may occur during the middle 
period of the attack. Respiration is slower than natural 
in most, but not in all cases. The tongue is usually white 
and moist, sometimes natural, but in prolonged cases it 
becomes yellow or dark. 

In some cases, on the second or third day or later, spots, 
from which the disease takes its name, " spotted fever," 
appear on the neck, breast or limbs, rarely on the face. 
They are red, purple or black, and distinct, but not elevated 
and do not disappear on pressure and may remain after 
death. They are either congested portions of the skin, 
or subcutaneous extravasations of blood. 

There may be an inflammation of the middle- ear with 
perforation of the drum membrane followed by otorrhcea. 
If the internal ear is involved there is a staggering gait 
after recovery. 

The duration of fatal cases is usually short. Some 
die within three or four hours; many within twenty- four. 
The first four days are the most perilous to life. After 
recovery blindness or deafness may remain. 

Sometimes the fever assumes a typhoid type. In these 
cases, the tongue becomes dark or purplish, sordes appear 
on the lips and teeth ; there is diarrhoea ; a tympanitic condi- 
tion of the abdomen; and the pulse is weak and irregular. 
The patient may finally recover, or die of weakness; and 
an attack may be followed by paralysis. 

The most frequent complications are pleurisy, and 
pneumonia. 



98 THE PRACTICE OF MEDICINE. 

Treatment: As soon as complete reaction from the 
chill has occurred administer 10 drops of the Fl. Ext. of 
Gelsemium and 2 or 3 drops of the Tr. of Veratrum Viride, 
hypodermically, after which administer the following by 
the mouth: 

Tr. of Veratrum Viride, 36 drops, 

Fl. Ext. of Gelsemium, 54 drops, 

FL Ext. of Echinacea, 6 drachms, 

Fl. Ext. of Baptisia Tinctoria, 36 drops, 

Water, 12 teaspoonf uls. 

Mix and give a teaspoonful every hour or every hour 
and a half. Should this fail to control the pain and 
muscular contractions in addition to it 5 drops of the Fl. 
Ext. of Gelsemium should be given, hypodermically, every 
two or three hours as is necessary for the relief of pain 
and muscular spasms. 

By all means keep the head cool. This may be accom- 
plished by pouring cold water on it; from time to time, as 
is necessary to accomplish the desired result. The feet 
must be kept warm. This may be accomplished by 
bathing them in warm water when they are cool and 
keeping hot rocks, bricks, irons, etc., applied to them. 
Calomel may be given at beginning of the attack, thus : 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, 1 grain. 

Mix and divide into five powders and give one every 
hour. Should they fail to act on the bowels give Oil, 
Salts or a Seidlitz Powder. 



EPIDEMIC CEREBRO-SPINAL MENINGITIS. 99 

Bromide of Soda is a valuable remedy in these cases 
and may be given, in connection with the Gelsemium, 
in 10 to 20-grain doses every two or three hours as it is 
required. Bromide of Potash may be used instead of the 
Bromide of Soda but it is thought to be harder on the 
stomach than the soda, 

If the foregoing fails to relieve the pain and muscular 
contractions J of a grain of the Sulphate of Morphine may 
be given, hypodermically, every two or three hours as is 
necessary to keep the patient quiet. The Morphine is 
thought to possess curative properties in these cases. 

If the pulse becomes weak or irregular give Digitalis 
and Cactus, adding the Echinacea and Baptisia, and if the 
pupils are dilated, Belladonna should also be added, thus: 

Fl. Ext. of Digitalis, 18 drops, 

Fl. Ext. of Echinacea, 6 drachms, 

Fl. Ext. of Baptisia, Tinctoria 36 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 12 teaspoonfuls. 

Mix and give a teaspoonful every two hours. 

Where children are having convulsions, in addition to 
the treatment already recommended, Chloral may be given 
every half-hour until relieved. The dose of it is one grain 
for each year of age up to twenty. 

Should an inflammation of the middle-ear occur the 
drum membrane should be punctured and the treatment 
for otorrhcea used. 

If the fever assumes a typhoid type treat it as such. 
See paralysis. 



ioo THE PRACTICE OF MEDICINE. 

DIPHTHERIA. 

Diphtheria is a general specific, infectious, and contagious 
disease; characterized by the formation of a tough, grayish, 
white membrane upon the mucous surfaces of the throat, 
glandular enlargements, fever and great prostration. 

It is caused by the Klebs-Loefler bacillus. It is a disease 
of childhood, though adults are subject to it. One attack 
predisposes to another. Bad hygienic surroundings increase 
its virulence and diffusion, although, the principal cause 
of its spread is contagion. Its average mortality is from 
30 to 40 per cent., and in laryngeal diphtheria as high as 75 
per cent. 

Symptoms: It sometimes begins with soreness of the 
throat, stiffness of the neck, tenderness in the region of 
the angles of the jaws, headache, loss of appetite, constipated 
bowels, scanty high-colored urine, and a chill, which is 
followed by fever. In other cases, the chill and the fore- 
going symptoms come on at the same time. 

The tongue is usually coated with a whitish or a brownish 
fur. The throat soon becomes red and swollen, sometimes 
dusky, especially that portion of it known as the fauces, 
palate and tonsils; and by the second day there will be 
noticed whitish or ash-colored spots in some part of the 
throat, usually on one or both tonsils. These spots spread 
until they coalesce and form a kind of membrane, which 
causes more or less difficulty in breathing and swal- 
lowing. 

In severe cases this membranous deposit is very profuse, 
sometimes extending into the nose, producing an offensive, 



DIPHTHERIA. 101 

watery discharge. At other times it extends downwards 
into the larynx; when, we have very much the same symp- 
toms as in croup ; such as hoarseness, loss of voice, a peculiar 
cough and great difficulty in breathing. This last-named 
trouble may grow worse and worse until breathing becomes 
impossible and unless relief is obtained death closes the 
scene. 

In other cases the membrane comes off leaving a raw, 
inflamed and bleeding surface, which is soon covered again 
with the peculiar formation. 

The average duration of an attack is about ten days. 
Of course, mild cases recover sooner. Relapses are com- 
mon. Paralysis of various parts of the body frequently 
follows the disease. Albuminuria is usually present. 

Treatment: As soon as the nature of the disease is 
discovered administer, hypodermically, 800 or 1,000 units 
of a reliable Diphtheria Antitoxin. Should a favorable 
result not be attained within twenty-four hours, then, 
administer in the same manner, 1,500 or 2,000 units and 
should there not be a decided improvement by the third 
day a similar dose should be administered. The injections 
should be made rather deeply into the subcutaneous 
cellular tissue of the thigh or buttock. 

Where patients have been exposed to the infection of 
the disease the hypodermic injection of 60 units of Diphtheria 
Antitoxin affords protection against the disease. Every 
antiseptic precaution should be used in injecting the 
Diphtheria Antitoxin. 



102 THE PRACTICE OF MEDICINE. 

Control the fever with sedatives ("fever-drops'') as 
in any other disease. If the pulse is too quick and too full 
give Veratrum or Aconite, the latter being the better remedy 
in these cases. If indicated add the Gelsemium and if the 
glands of the neck are enlarged Phytolacca should be 
given and Echinacea should be given in all cases, thus : 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Gelsemium, ' 27 drops, 

Fl. Ext. of Phytolacca Decandra,. . .18 drops, 

Fl. Ext. of Echinacea, 6 drachms, 

Water, 12 teaspoonf uls. 

Mix and give a teaspoonful every hour and a half or 
two hours while the pulse is too quick and too full. 

Or if the patient is drowsy, the pupils being too large 
and the feet and hands cool, Belladonna should be used 
as follows: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Fl. Ext. of Phytolacca Decandra, ...18 drops, 

Fl. Ext. of Echinacea, 6 drachms, 

Water, ..12 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half or 
two hours while the pulse is too quick and too full. 

Where the pulse is weak or irregular give Digitalis 
and Cactus adding the Phytolacca and Echinacea and, 
if indicated the Belladonna, thus: 

Fl. Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grandiflorus, 24 drops, 

Fl. Ext. of Belladonna, 6 drops, 



DIPHTHERIA 103 

Fl. Ext. of Echinacea, 6 drachms, 

Water , 6 teaspoonfuls. 

Mix and give a teaspoonful every two hours. Where 
the pulse is very weak 1-40 of a grain of the Nitrate of 
Strychine should be given every three or four hours. 

Whiskey should be used freely in these cases and if 
necessary the Aromatic Spirits of Ammonia may be used. 
The proper amount of Whiskey for a child two years 
old is from a half to a teaspoonful every two or three 
hours; an adult from two to four drachms every two or 
three hours. 

At the beginning of the attack Calomel may be admin- 
istered, thus: 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, 1 grain. 

Mix and divide into five powders and give one every 

hour. Should they fail to act on the bowels give Oil or Salts. 

As soon as the Calomel has acted on the bowels commence 

the administration of the Sulphide of Calcium. It may be 

given in J-grain doses every three hours. 

Many remedies have been used as local applications 
for the throat. For this purpose the following is probably 
one of the best : 

Peroxide of Hydrogen, 2 ounces, 

Water, 2 ounces. 

Mix and use in the nose and throat every hour or two 
with an atomizer. By this means the nose is kept clean 
thereby preventing the extension of the disease to the nasal 



104 THE PRACTICE OF MEDICINE. 

cavities. The tube and nozzle of the atomizer should be 
of hard rubber or glass as contact with metal favors the de- 
composition of the Peroxide. The following is also valuable: 

Carbolic Acid, 20 drops, 

Tr. of Muriate of Iron, 4 drachms, 

Glycerine, 1 ounce, 

Water, sufficient to make, 4 ounces. 

Mix and swab the throat every three hours. In children 
this must be done very gently as, otherwise, more harm 
than good may result. 

Where the glands of the throat are swollen the following 
may be used : 

Gum Camphor, \ ounce, 

Carbolic Acid, \ ounce, 

Alcohol, 2 drachms, 

Glycerine, 2 drachms, 

Olive Oil, 1 J ounces. 

Mix and apply externally to the throat every three or 
four hours. 

The atmosphere of the sick-room should be kept impreg- 
nated with the steam from the following: 

Spirits of Turpentine, 1 ounce, 

Carbolic Acid, 1 drachm, 

Water, 1 quart. 

Mix and put it in a broad vessel, place the vessel on 
an oil stove and regulate the heat as is required. 

Where the urine is scanty 30 drops of the Fl. Ext. of 
Buchu may be given every three or four hours until the 
condition is relieved. 



DIPHTHERIA. 105 

The diet must be of the most nutritious character, 
consisting of such articles as milk, eggs, chicken-tea, 
beef-tea, etc. If the act of swallowing is very painful or 
impossible, nutritious enemas should be used, the follow- 
being a good formula: 

Milk, 1 ounce, 

Whiskey, \ ounce, 

Egg, one, 

Salt, sufficient. 

Mix, beat thoroughly, warm and use. 
Where the larynx is involved and there is danger of 
suffocation, intubation or tracheotomy should be resorted 
to, however, no one but a competent surgeon should 
undertake this. 

Plenty of sunlight and fresh air must be admitted to 
the sick-room. 

Should paralysis follow, it may usually be relieved 
with Nux Vomica. 



PART III. 

DISEASES OF THE RESPIRATORY APPARATUS. 

The respiratory apparatus consists of the nares, 
pharynx, larynx, trachea, lungs and their covering. 

ACUTE NASAL CATARRH. 
coryza; cold. 

This is an inflammation of the mucous membrane 
lining the nose and the cavities communicating with it; 
characterized by more or less fever, fulness, and discomfort 
in the head. It is popularly known as "cold" or "cold 
in the head." 

Its principal causes are exposure and changeable 
weather. Authorities state that the disease probably 
depends upon a micro-organism. An inflammation of 
the lining membrane may also be produced by irritating 
fumes, such as those of Iodine, Mustard, or Ammonia. 

Symptoms: An attack usually begins with languor, 
headache, a "stuffing up" of the nose, chilliness, followed 
by more or less fever and pain in various parts of the body. 
The nose becomes dry and there is more or less sneezing. 
The tear-ducts are swollen; the eyes watery; the sense of 
smell is lost; the sense of taste impaired, and there is more 
or less soreness of the throat. If the larynx is involved 



108 THE PRACTICE OF MEDICINE. 

the voice is husky, sometimes lost; and where the inflam- 
mation extends to the Eustachian tubes there may be 
impairment of hearing. Bronchial irritation with more 
or less cough is common in severe cases. The tongue is 
slightly coated, the bowels constipated and the urine scanty 
and high colored. This condition lasts from one to three 
or four days and is followed by free secretion from the 
nose and a gradual disappearance of the symptoms. 

Treatment: The free use of hot drinks, such as hot 
lemonade or a " vinegar stew" containing Ginger and 
Pepper followed by a hot foot-bath and the administration 
of the following, just before retiring for the night, will 
usually afford relief: 

Sulphate of Quinine, 5 grains, 

Dover's Powder, 8 grains. 

Mix and administer at one dose. 

Fever, when present, should be controlled with sedatives 
(" fever-drops") as in any other disease. 

If the bowels are constioated give Oil, Salts or a Seidlitz 
Powder. 

Where there is scantiness of urine administer the fol- 
lowing : 

Acetate of Potash, 5 drachms, 

Water, 2 ounces. 

Mix and give a teaspoonful, in a sup of water, every 
three hours. 

Where there is soreness of the throat add as much 
Chlorate of Potash to a glass of water as it will dissolve 
and use as a gargle every hour. At the same time the 



CHRONIC NASAL CATARRH. 109 

throat should be bathed with Spirits of Turpentine and, 
then, well wrapped with flannel. 

When cough is present, it may be relieved with the 
following : 

Tr. of Lobelia, 1 J drachms, 

Fl. Ext. of Ipecac, \ drachm, 

Syrup of Wild Cherry, to make, 4 ounces. 

Mix and give a teaspoonful every three hours. 

CHRONIC NASAL CATARRH. 

Chronic nasal catarrh is a chronic inflammation of the 
mucous membrane lining the nasal passages, with more 
or less alteration of structure; characterized by a sense 
of fullness in the nose, increased nasal secretion, an impair- 
ment of the sense of smell, and hearing. 

Its most common causes are frequent attacks of the 
acute variety of the disease, scrofula and syphilis. 

Symptoms : A feeling of fullness in the nose, an increase 
of the secretion, which is thick and of a greenish color 
and often very offensive. It sometimes collects in the 
recesses of the nose and forms hard crusts, which are 
removed with difficulty. Where ulceration of the lining 
of the nose occurs the discharge . has a foetid odor and is 
called ozena. 

The mucous membrane is either thickened and of a 
dark-red color, or it is thin, pale and atrophied. The 
last-mentioned condition is especially seen in cases of 
long standing. Where the inflammation involves the 
back part of the nose and upper part of the pharynx, there 



no THE PRACTICE OF MEDICINE. 

is a constant "hawking," to clear the throat, especially 
of a morning, immediately after arising. 

Sudden changes of temperature, and exposure cause 
frequent relapses, with increased severity of the symptoms 
when, the difficulty in breathing through the nose is in- 
creased. 

The special sense of smell is often impaired and not 
infrequently entirely abolished ; the special sense of hearing 
is more or less diminished, from an extension of the inflam- 
mation to the Eustachian tubes. When the disease extends 
to the frontal sinuses there is a constant frontal headache, 
with a feeling of weight. When the inflammation extends 
to, and obstructs the nasal ducts the tears flow over the 
cheeks and there is more or less congestion or irritation 
of the eyes. 

Permanent cures are seldom effected, the disease being 
so decidedly chronic, the treatment is necessarily pro- 
tracted and most patients tire of it before a complete 
cure is effected. 

Treatment : This should be commenced in the spring 
as the weather at this time is less changeable, therefore, 
relapses are not so liable to occur. 

If the patient is scrofulous or syphilitic in addition to 
local treatment the following should be used: 

Bichloride of Mercury, i\ grains, 

Iodide of Potash, i ounce, 

Water, sufficient to make, 6 ounces. 

Mix and give a teaspoonful after each regular meal. 



CHRONIC NASAL CATARRH. in 

Or: 

Iodide of Potash, i ounce, 

Compound Syrup of Stillingia, to make, 6 ounces. 
Mix and give a teaspoonful after each regular 
meal. 

If the patient is debilitated a tonic should be used in- 
stead of the foregoing and the following answers admir- 
ably in these cases: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Canadensis, . . 1 ounce, 

Fowler's Solution of Arsenic, i\ drachms, 

Aromatic Elixir, sufficient to make, . 6 ounces. 
Mix and give a teaspoonful before each regular meal. 
If the patient is suffering with chronic constipation, 
it must be overcome by the administration of the Fl. Ext. 
of Cascara Sagrada. It may be given with the tonic. 

The nasal passages should be thoroughly cleansed 
with the following: 

Carbolic Acid, 4 drops, 

Bicarbonate of Soda, 20 grains, 

Borate of Soda, 20 grains, 

Glycerine, 4 drachms, 

Water, sufficient to make, 4 ounces. 

Mix and use with an atomizer or a proper syringe 
several times a day. After which, if the mucous mem- 
brane is full and turgid, use the following: 

Ichthyol, 2 drachms, 

Glycerine, 6 drachms. 



ii2 THE PRACTICE OF MEDICINE. 

Mix and apply thoroughly to all parts of the nasal 
cavity. 

The following may also be used with decided benefit 
in these cases: 

Powd. Sanguinaria, i drachm, 

Tannic Acid, 5 grains, 

Powd. Camphor, 1 drachm, 

Menthol, 2 grains, 

Subnitrate of Bismuth, 2 drachms. 

Mix and use as a snuff every four hours after cleansing 
the nose. 
Or: 

Chloride of Ammonia, 1 drachm, 

Glycerine, 2 drachms, 

Fl. Ext. of Pinus Canadensis, 1 ounce, 

Water, sufficient to make, 2 ounces. 

Mix and after cleansing the nose drop ten drops into 
each nostril three times a day. 

In some cases a permanent cure cannot be effected 
without the aid of surgery. 

LA GRIPPE. 

INFLUENZA. 

La grippe is an acute, infectious, pandemic disease, 
characterized, anatomically, by a catarrhal condition of 
the respiratory tract and sometimes the digestive; clinically, 
by chilliness, fever, severe headache, pains in the eyes, 
muscles and joints, sneezing, injected, watery eyes, and 
a severe cough. 



LA GRIPPE. 113 

It is caused by the bacillus of Pfeiffer, which is unin- 
fluenced by soil, climate, season, or atmospheric condi- 
tions. Following the pandemic, there are, as a rule, for 
several years endemic or epidemic outbreaks of the 
disease in different localities. It is thought to be conta- 
gious, and one attack predisposes to another. The first 
epidemic of the disease in the United States was in 1647. 

Symptoms: An attack is usually ushered in suddenly 
with a well-marked chill or rigor followed by fever, the 
temperature reaching 103 to 105 degrees. The patient 
complains of chilliness along the spine after the appearance 
of the fever. The pulse is full and quick, the face flushed; 
and there is severe headache with acute pains in the eyes 
and frontal sinuses; there is sneezing, pains in the muscles, 
throat and joints, and a dry cough, which soon becomes 
loose, and is accompanied by slight difficulty in breathing 
and more or less soreness in the chest and throat. 

The tongue is usually furred and there is frequently 
vomiting. The bowels are constipated, except when the 
digestive tract is involved, when there may be diarrhoea 
or dysentery. The urine is usually scanty and high colored. 

In from four to seven days the fever declines and a 
protracted convalescence ensues, the patient being debil- 
itated altogether out of proportion to the severity of the 
attack. Its most frequent complications are bronchitis 
and pneumonia. 

Relapses are common. An attack may be followed 
by persistent headache, neuralgia, neuritis, insomnia, 
mania, enlargement of the lymphatic glands, etc. 



ii 4 THE PRACTICE OF MEDICINE. 

Treatment: Control the fever. This may be accom- 
plished by the administration of sedatives according to 
indications. If the pulse is too quick and too full give 
Veratrum or Aconite, and if there are flushed face and 
bright eyes, the pupils being too small, add Gelsemium, 
and if cough is present add Lobelia, thus: 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Tr. of Lobelia, 36 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half or 
two hours while there is fever. 

If the stomach is irritated give Aconite instead of the 
Veratrum, adding the Gelsemium and Lobelia, as follows: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Tr. of Lobelia, 36 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half or 
two hours while there is fever. If the patient is drowsy, 
the pupils being too large, give Belladonna instead of the 
Gelsemium. If the patient complains of muscular sore- 
ness 3 drops of the Fl. Ext. of Cimicifuga shoujd be added 
to each dose of the " fever-drops. " 

Where the fever is very high and the skin dry from 3 
to 5 grains of Acetanilide may be given every three or four 
hours. 

Where there is pain in the side or breast apply hot 
salt, changing it as soon as it becomes cool. 



LA GRIPPE. 115 

The patient should have at least one action a day from 
the bowels. To procure this, when necessary, give Oil, 
Salts or a Seidlitz Powder; or if indicated, the following 
may be used : 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, 1 grain. 

Mix and divide into five powders; give one every hour. 
If there is scantiness of urine give 20 grains of the 
Acetate of Potash every three or four hours. 

If the fever is remittent give Quinine as is recommended 
in remittent fever. 

If the pulse is weak or irregular give Digitalis and Cactus 
instead of the Veratrum or Aconite, adding the Lobelia 
and Belladonna, if indicated, thus: 

Fl. Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grandiflorus, 24 drops, 

Fl. Ext. of Belladonna, .6 drops, 

Tr. of Lobelia, 36 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every two hours. Whiskey 
may also be used in these cases; and if there is great pros- 
tration the 1-40 of a grain of the Sulphate of Strychnine 
may be given every three or four hours. 

Should the cough continue after convalescence is estab- 
lished give the following: 

Tr. of Lobelia, 1 \ drachms, 

Fl. Ext. of Ipecac, \ drachm, 

Syrup of Wild Cherry, sufficient to make, .4 ounces. 



n6 THE PRACTICE OF MEDICINE. 

Mix and give a teaspoonful every three hours. 
Where an attack is complicated with pneumonia treat 
it as such; and where an attack is followed by neuralgia 
the treatment recommended for that malady should be 
given. 

For the purpose of aiding the patient in regaining his 
former strength, as soon as convalescence is fully estab- 
lished give the following: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Canadensis, 1 ounce, 

Aromatic Elixir, sufficient to make, . . 6 ounces. 
Mix and give a teaspoonful before each regular meal. 

ACUTE PHARYNGITIS. 

ACUTE SORE THROAT. 

This is an acute inflammation of the mucous mem- 
brane of the tonsils, uvula, soft palate and pharynx; char- 
acterized by chilliness, fever, dryness and soreness in the 
throat, difficulty in swallowing and a constant desire to 
clear the throat. 

Its most common causes are changeable weather, 
exposure to cold and wet and the swallowing of hot food 
and liquids and the action of irritating vapors. It also 
occurs as a result of scarlet fever, measles, erysipelas, 
diphtheria, la grippe and small-pox. 

Symptoms: An attack usually commences with chil- 
liness followed by more or less fever, furred tongue, con- 
stipated bowels, dryness and soreness of the throat, head- 
ache, loss of appetite, pain and difficulty in swallowing, a 
cough and a constant desire to clear the throat with more 



ACUTE PHARYNGITIS. 117 

or less nausea. As the inflammation proceeds secretion is 
established, the discharge finally becoming yellowish, 
when, the inflammation subsides. 

Occasionally there is the formation of pus in the sub- 
mucous and deeper tissues of the pharynx, constituting 
a retro-pharyngeal abscess. This condition may follow a 
wound from a sharp piece of bone or be secondary to 
caries of a cervical vertebra. 

When the inflammation extends to the larynx, there 
is hoarseness and sometimes loss of voice; and when it 
extends to the Eustachian tubes there is dullness of hearing. 
An attack seldom lasts longer than from three to five 
days. 

Treatment: When fever is present give sedatives 
according to indications as in any other disease. If the 
bowels are constipated give Oil, Salts or a Seidlitz Powder; 
or, if particularly indicated give the following: 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, " 1 grain. 

Mix and divide into five powders and give one every 
hour. 

If there is scantiness of urine give 20 grains of the 
Acetate of Potash or 30 drops of the Fl. Ext. of Buchu 
every three or four hours. 

Locally, Chlorate of Potash is all that is required. 
A teaspoonful of it may be added to a glass of water and 
used as a gargle every hour. The following also answers 
a good purpose: 



n8 THE PRACTICE OF MEDICINE. 

Fl. Ext. of Baptisia, i ounce, 

Fl. Ext. of Hydrastis Canadensis, 1 ounce, 

Chlorate of Potash, 2 drachms, 

Water, 4 ounces. 

Mix; use as a gargle or with an atomizer every hour. 
Where there is ulceration, in addition to the gargles 
recommended, use the following: 

Nitrate of Silver, 20 grains, 

Water, 1 ounce. 

Mix and apply with a soft mop once or twice a day. 
If the throat is raw and inclined to bleed use the fol- 
lowing : 

Perchloride of Iron, 1 drachm, 

Glycerine, 7 drachms. 

Mix and apply with a soft mop once or twice a day. 
If the attack is a severe one great relief may be given 
by applying cloths, wrung out of hot water, to the angles 
of the jaws, changing them frequently. 

Should an abscess form evacuate the pus early, and 
if the patient is debilitated, especially during convales- 
cence, give the following: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Canadensis, . . . 1 ounce, 
Aromatic Elixir, sufficient to make, . 6 ounces. 
Mix and give a teaspoonful before each regular meal. 

CHRONIC PHARYNGITIS. 

CHRONIC SORE THROAT. 

This is a chronic inflammation of the mucous mem- 
brane of the larynx; characterized by a sensation of dryness 



CHRONIC PHARYNGITIS. 119 

and tickling or burning in the throat with frequent hawk- 
ing to expel the accumulation of viscid mucus. 

Its most common causes are frequent attacks of the 
acute variety, excessive smoking and drinking, continued 
exposure to cold air, excessive use of the voice, etc. 

Symptoms: These are a sensation of dryness and 
tickling or burning in the throat with frequent short cough 
or hawking to clear the throat, especially upon first rising 
in the morning. Acute exacerbations are frequent; and 
if the larynx is involved there is hoarseness with a dry, 
hacking cough. 

On examination the mucous membrane is found thick- 
ened and laid together in folds, or presenting a flabby, 
relaxed appearance; the mucous follicles enlarged and the 
color changed from pink to a dusky-red, livid, or bluish 
color. 

Treatment: This variety of pharyngitis is a very 
difficult disease to cure. Where the patient's general 
health is impaired in addition to the local remedies, the 
proper constitutional treatment should also be adopted. 

If there is any trace of impure blood give the follow- 
ing 1 

Iodide of Potash, 1 ounce, 

Compound Syr. Stillingia, sufficient to make, . 6 ounces. 
Mix and give a teaspoonful after each regular meal. 
Or: 

Bichloride of Mercury, \\ grains, 

Iodide of Potash, 1 ounce, 

Water, sufficient to make, 6 ounces, 



120 THE PRACTICE OF MEDICINE. 

Mix and give a teaspoonful after each regular meal. 

As a local application use the following: 

Tr. of Myrrh, i ounce, 

Tr. of Capsicum, 2 drachms, 

Fl. Ext. of Baptisia Tinctoria, 1 ounce, 

Water, sufficient to make, 4 ounces. 

Mix and use as a gargle three or four times a day. 

Or:. 

Carbolic Acid, 10 drops, 

Tr. of Iodine, 2 drachms, 

Glycerine, 6 drachms. 

Mix and use with a soft mop three times a day. 
Should the foregoing fail, try the following: 

Nitrate of Silver, 20 grains, 

Water, 1 ounce. 

Mix and use with a soft mop twice a day. 
In the treatment of pharyngitis it is important to bear 
in mind that the upper part of the pharynx is situated 
behind and above the soft palate, which hides it from 
view upon an ordinary examination through the mouth; 
and when a remedy is applied the operator should be 
careful to apply it to all parts of the pharynx. 

ACUTE LARYNGITIS. 

ACUTE INFLAMMATION OF THE LARYNX. 

Is an acute catarrhal inflammation of the mucous mem- 
brane of the larynx; characterized by feverishness, cough, 
soreness of the throat, hoarseness and more or less diffi- 
culty in breathing and swallowing. 



ACUTE LARYNGITIS. 121 

Its most common causes are exposure to cold and 
dampness, wounds of the larynx, the inhalation of irritating 
vapors or dust, the cigaret-habit, drinking concentrated 
alcoholic liquors, prolonged public speaking or singing, 
violent fits of crying, etc. 

Symptoms: It usually commences with a slight chill 
or chilliness, pain and a sensation of dryness and rawness 
in the larynx, with hoarseness, a dry cough, and a disposi- 
tion to clear the throat. Fever usually follows and there 
is more or less difficulty in breathing and swallowing. 
The cough, which was at first dry, becomes loose in the 
course of twenty-four or forty-eight hours, and the matter 
expectorated is sometimes streaked with blood. In some 
cases there is a loss of voice (aphonia), caused by an in- 
volvement of the vocal cords, which are located in the 
larynx. There is sometimes, oedema of the glottis (a 
dropsical swelling), which produces, if prompt relief is 
not obtained, suffocation and death. In children there 
may be a spasmodic contraction of the glottis (upper 
part of the larynx), especially during the night, which 
almost, if not quite, stops breathing for the time being. 

Treatment: The patient should be put to bed and 
the temperature of the room kept uniform, and the air 
moist by the constant boiling of a vessel of water in the 
room. At the beginning of the attack give a full dose of 
Oil or Salts and bathe the feet in strong Mustard -Water, 
as hot as it can be borne. Bathe the throat thoroughly 
with Compound Stillingia Liniment, then, apply flannel 
cloths, wrung out of hot water, to the neck, changing 



122 THE PRACTICE OF MEDICINE. 

them sufficiently often to prevent their becoming cool. 
The patient should also inhale the steam from equal parts 
of hot water and vinegar frequently, a few minutes at a 
time; or instead of the vinegar Spirits of Turpentine may 
be added to the water and used in the same manner. 

When fever is present it should be controlled with 
sedatives (" fever-drops") as in any other disease. An 
inflammation is controlled with precisely the same reme- 
dies with which we control fever. 

When the breathing becomes hard, especially during 
inspiration, and the voice hoarse, soon sinking to a whis- 
per, there is oedema of the glottis setting up. This demands 
prompt recognition and treatment, which should consist 
of the administration of 30 drops of the Fl. Ext. of Jabo- 
randi every half-hour until it produces perspiration, or an 
increased flow of saliva. Should the patient be unable 
to swallow, the hypodermic injection of ^ of a grain of the 
Hydrochlorate of Pilocarpine every thirty minutes until 
it produces similar effects to that of Jaborandi, will usually 
lessen the swelling. The Fl. Ext. of Lobelia in from 
5 to 20-drop doses every ten to twenty minutes until 
nausea, or even vomiting, is produced, is also a valuable 
remedy in these cases. 

Should the foregoing fail to give relief, an opening 
(tracheotomy) will have to be made in the trachea (wind- 
pipe) and a tube inserted and retained there in order to 
prevent suffocation until the swelling subsides. 

When there is a spasmodic contraction of the glottis 
the cough is harsh and dry and there is a sudden attack 



CHRONIC LARYNGITIS. 123 

of difficult breathing amounting, almost, to a cessation. 
The child should at once be placed in a tub of hot water 
and flannel cloths wrung out of the same and applied 
to the neck, changing them frequently to prevent their 
becoming cool. 

The inhalation of a few drops of Chloroform usually 
affords prompt relief. A sufficient quantity of it to pro- 
duce anaesthesia should not be given, as this is unneces- 
sary ; 

To prevent a recurrence of the attack Lobelia should 
be administered sufficiently often to produce continuous 
nausea. 

CHRONIC LARYNGITIS. 

minister's sore throat. 

This is a chronic inflammation of the mucous mem- 
brane of the larynx; characterized by an insidious onset, 
irritation, slight soreness and a contraction of the throat 
when speaking, alteration of the voice and a cough. 

Its most common causes are frequent acute attacks, 
an extension of the inflammation from chronic pharyn- 
gitis, the long-continued use of the voice as in public 
speaking or singing ; the inhalation of irritants, as tobacco 
smoke, etc. ; the immoderate use of alcoholic liquors and 
syphilis. 

Symptoms: Chronic laryngitis is insidious in its onset, 
patients frequently not being aware of its presence until 
the disease is fully confirmed. The first symptoms are 
irritation, slight soreness, more or less cough and a spas- 
modic contraction of the larynx after immoderate use of 



124 THE PRACTICE OF MEDICINE. 

the vocal organs; however, these symptoms are sometimes 
met with in those who have not over exerted the vocal 
organs. There is hawking to clear the throat; the voice 
is rough and harsh, sometimes sinking to a whisper during 
a discourse. These symptoms usually subside in a short 
time, the patient believing the attack to have been pro- 
duced by a slight cold. As the disease progresses these 
attacks become more frequent, continue longer, the symp- 
toms not entirely disappearing. When the disease is 
fully established there is a constant uneasy sensation in 
the larynx; the voice is greatly altered and there is a con- 
stant annoying cough. The material expectorated, at 
first, is scanty and consists of mucus, but later becomes 
purulent and not infrequently streaked with blood. Hem- 
orrhage in the latter stages is not uncommon and may 
be profuse. Those afflicted with the disease take cold 
upon the slightest atmospherical change. 

The general health of patients is usually impaired 
in proportion to the severity of the disease and not infre- 
quently tuberculosis of the lungs is developed, soon termi- 
nating in death. 

Treatment: Public speaking and singing must be 
abandoned for a time and all exposure avoided. 

Where the patient is debilitated and the appetite not 
good, give the following: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Canadensis, . . . 1 ounce, 
Aromatic Elixir, sufficient to make, . 6 ounces. 

Mix and give a teaspoonful before each regular meal; 



CHRONIC LARYNGITIS. 125 

and for its effects on the larynx, at the same time, admin- 
ister the following : 

Fl. Ext. of Collinsonia Canadensis, . . 1 ounce, 

Aromatic Elixir, 3 ounces. 

Mix and give a teaspoonful four times a day. 
If the patient has any impurity of the blood, or if he 
is syphilitic, give the following: 

Iodide of Potash, 1 ounce, 

Bichloride of Mercury, 1 \ grains, 

Water, sufficient to make, 6 ounces. 

Mix and give a teaspoonful after each regular meal. 
Or: 

Iodide of Potash, 1 ounce, 

Compound Syr. of Stillingia, suffi- 
cient to make, 6 ounces. 

Mix and give a teaspoonful after each regular meal. 
Local treatment is of great importance in these cases, 
and not only the larynx itself but also the nose and pharynx 
should be kept perfectly clean or as near so as possible. 
For this purpose we know of nothing better than the 
following : 

Carbolic Acid, 6 drops, 

Bicarbonate of Soda, 30 grains, 

Borate of Soda, 30 grains, 

Glycerine, 6 drachms, 

Water, sufficient to make, 6 ounces. 

Mix and spray the nose, pharynx and larynx with it 
every three or four hours. 



126 THE PRACTICE OF MEDICINE. 

Where there is dryness of the larynx the following 
should be used: 

Chlorate of Potash, 2 drachms, 

Water, 6 ounces. 

Mix and use every three or four hours with an atomizer 
after the parts have been cleansed as previously directed. 
Or: 

Chloride of Ammonia, 30 grains, 

Water, 6 ounces. 

Mix and use in the same manner. 
Where there is excessive secretion, the following should 
be used instead of the foregoing: 

Sulphocarbolate of Zinc, 18 grains, 

Water, 6 ounces. 

Mix and also use with an atomizer every three or four 
hours after the parts have been cleansed as previously 
directed. 

In severe cases the following may be used : 

Tannin, 10 grains, 

Glycerine, 1 ounce. 

Mix and apply directly to the larynx with a cotton- 
swab or a camel's-hair brush. 
Or: 

Nitrate of Silver, 10 grains, 

Water, 1 ounce. 

Mix and use in the same manner. 
Tobacco and alcoholic drinks, when used, must be 
abandoned and crowded and overheated rooms avoided. 
Should tuberculosis of the lungs develop treat it as such. 



APHONIA. 127 

APHONIA. 

LOSS OF VOICE. 

Loss of voice is really only a symptom of disease and 
may be temporary or permanent. Temporary aphonia 
is quite common in croup, laryngitis and colds. A per- 
manent aphonia may result from a thickening of the mucous 
membrane covering the vocal cords, hypertrophy, atrophy 
or ulceration of the cords themselves; and it may be caused 
by intense exitement, over exertion of the vocal organs, 
or a paralysis of the muscles of the larynx. 

Symptoms: Where it results from cold without in- 
flammation of the larynx, the loss of voice, which is sudden 
and complete, is preceded a few days by hoarseness. 

Where it is produced by ulceration or inflammation 
the loss of voice is gradual ; there is more or less cough and 
the material expectorated consists of mucus or mucus 
and pus. When occurring as a result of thickening of the 
mucous membrane covering the cords, hypertrophy or 
atrophy, the loss of voice is usually gradual; and where 
it results from paralysis the loss may be sudden or gradual 
and may or may not be attended by inflammation. 

Treatment: Patients should not under any circum- 
stances attempt to use the voice even in cases of partial 
aphonia. 

Where there are symptoms of inflammation the treat- 
ment recommended for acute laryngitis should be adopted. 
Where it is caused by ulceration a solution of Nitrate of 
Silver should be applied directly to the part. 



128 THE PRACTICE OF MEDICINE. . 

Where it is a result of paralysis give 3 or 4 drops of the 
Fl. Ext. of Nux Vomica before each regular meal; and 
at the same time electricity in the form of the Galvanic 
current should be used once or twice a day passing the 
current from the head downward. 

The inhalation of the following is recommended: 

Oil of Cajeput, 1 drachm, 

Oil of Stillingia, 1 drachm, 

Alcohol, 2 ounces. 

Mix, wet a cloth with it and inhale the vapor a few 
minutes every hour or so. 

If there is any impurity of the blood appropriate reme- 
dies to overcome it should be given. 

SPASMODIC LARYNGITIS. 

CROUP. 

Croup is a catarrhal inflammation of the mucous 
membrane of the larynx associated with spasmodic con- 
tractions of the glottis; characterized by a dry, harsh, 
ringing, metallic cough, difficult breathing and attacks of 
threatened suffocation. 

Its most common causes are atmospherical changes 
or cold, excitement, violent emotions and excesses in 
eating and drinking. It is a disease of childhood. 

Symptoms: An attack is sometimes preceded for a 
day or two by the symptoms of cold, such as hoarseness 
and cough. In other cases, the child retires at night, 
apparently in health, and after several hours' sleep it is 
suddenly awakened by a paroxysm of difficult breathing, 
amounting, in some cases, to almost suffocation. There 



SPASMODIC LARYNGITIS. 129 

is a dry, harsh, ringing, metallic cough and after a few 
minutes to one or two hours, the breathing becomes easier, 
the cough less harsh, the skin moist and the child falls 
asleep. 

On the following day the respirations are usually nor- 
mal but there is more or less cough. Unless prevented 
by treatment about the same hour the following night, 
the paroxysms recur. 

At the commencement of the attack there is frequently 
more or less fever, the skin hot and dry and the pulse 
quick and strong, but when relief is not promptly obtained, 
the extremities become cold, the body covered with a cold, 
clammy perspiration, and the pulse weak and rapid. How- 
ever alarming the paroxysms may be to parents and friends, 
death rarely ever occurs from simple croup. 

Treatment: Put the patient in a tub of warm water, 
as hot as can be borne and apply cloths wrung out of the 
same to the throat. Administer from 10 to 20 drops of 
the Tr. of Lobelia, which is a specific, every ten or fifteen 
minutes until relief is obtained or vomiting produced; 
and if there is fever administer sedatives (" fever-drops") 
according to indications. 

The inhalation of a few drops of Chloroform usually 
affords prompt relief, however this should not be carried 
to complete anaesthesia. 

Ipecac, in the form of the Syrup, in half-teaspoonful 
doses, or the Fl. Ext., in 15 to 30-drop doses, is very 
efficient. Prof. Bartholow recommends Turpeth Mineral, 
in from 1 to 3-grain doses. Prof. Da Costas suggests 



1 36 THE PRACTICE OF MEDICINE. 

the cautious use of the Hydrochlorate of Apomorphine 
in 1-10-grain doses, hypodermically. Tickling the fauces 
with a feather, or the finger, until vomiting is produced 
is also very efficient. Powd. Alum may also be used. 
When the patient is relieved administer Oil or Salts to 
empty the bowels. 

CROUPOUS LARYNGITIS. 

MEMBRANOUS CROUP; TRUE CROUP. 

This is an acute inflammation of the mucous mem- 
brane of the larynx, attended with the formation of a false 
membrane and the occurrence of spasm of the glottis; 
characterized by fever, a peculiar, harsh, dry, metallic 
cough, difficult breathing, with a loud respiratory sound 
and usually loss of voice and a tendency toward death 
by suffocation. 

The disease occurs, most commonly, during damp 
winters and is a disease of childhood, occurring usually 
in the strong and vigorous, well-nourished males. Most 
authorities state that the disease is identical with laryn- 
geal diphtheria, but this is very probably a mistake, as 
membranous croup is a local disease, while diphtheria 
is a constitutional disease with a local manifestation. 

Symptoms: Fortunately this form of croup is rare. 
It usually begins with cold, its progress being gradual. 
There is a gluey material, called plastic lymph, deposited 
on the mucous membrane of the larynx. This material 
adheres to the throat until, in some cases, the larynx 
is completely closed. Ordinarily there is more or less 
hoarseness with a cough for several days, sometimes a 



CROUPOUS LARYNGITIS. 131 

week, before the attack begins. The breathing, during 
this time, is accompanied by a dry, whistling noise, which 
may frequently be heard across the room. The hoarse- 
ness soon becomes worse; the cough aggravated; the 
patient not yet being confined to bed. Sometime during 
the night the child is aroused by difficult breathing or 
an attack of coughing; and, upon examination, it will be 
discovered that the patient has fever, a dry skin and an 
accelerated pulse. The hoarseness soon increases until 
there is complete loss of voice; the paroxysms of difficult 
breathing become severe and frequent; the whistling 
noise augmented; and the cough ringing and trouble- 
some. These symptoms increase as the disease advances 
and if relief is not obtained the lips become blue, the 
veins full, the extremities cold, the skin purplish, the 
patient languid, finally sinking into a stupor when death 
soon closes the scene. 

In other cases the membrane; or part of it, is expelled, 
the cough becomes loose and the attacks of suffocative 
breathing less frequent, the fever subsides, the voice 
returns and the patient slowly recovers. 

This may be distinguished from spasmodic croup 
by the constantly increasing difficulty in breathing, the 
dryness and whistling noise produced by the air passing 
through the larynx and the peculiar, dry metallic cough. 
The duration of an attack is usually from a week to ten 
days. 

Treatment: Control the fever with the indicated 
sedatives as in any other disease. 



132 THE PRACTICE OF MEDICINE. 

The inhalation of the vapor of freshly burned and 
slaked Lime is one of our most efficient means for detach- 
ing the false membrane, therefore, its use should not be 
neglected. 

Flannel cloths, wrung out of hot water, should be 
applied to the throat and changed sufficiently often to 
prevent their becoming cold. 

To prevent the formation of the membranous exuda- 
tion Calomel is one of our most efficient remedies. It 
may be used as in the following formula: 

Calomel, 2 grains, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, 1 grain. 

Mix; divide into ten powders; give one every two hours. 

Where the respiration is greatly obstructed by the 
membrane its detachment and expulsion may fre- 
quently be accomplished by emetics. For this purpose 
Turpeth Mineral (Hydrargyri Subsulphas Flavus) in 
2 -grain doses, for a child two years old, repeated as often 
as is required by the obstructed breathing, is one of our 
most efficient remedies. The Fl. Ext. of Ipecac and also 
the Tr. of Lobelia may be used as emetics in these 
cases and are probably as efficient as the Turpeth Mineral. 

The use of all irritating or caustic applications to the 
fauces or larynx are positively contra- indicated. 

Where the pulse becomes weak or irregular Digitalis 
and Cactus together with Whiskey should be used as 
indicated. Where these means fail to give relief trache- 
otomy or intubation should be resorted to. 



PERTUSSIS. 133 

PERTUSSIS. 

WHOOPING COUGH. 

This is an acute, specific, contagious affection; char- 
acterized by more or less fever, catarrh of the respiratory 
mucous membrane followed by a dry, paroxysmal, 
convulsive cough, there often being a loud crowing 
inspiration or "whoop" during the paroxysm. 

All ages are subject to it and second attacks of the 
disease, which are known as Nurse's cough are quite 
common. It is probably caused by the Bacillus tussis 
convulsivse. 

Symptoms: After a variable length of time, though 
more commonly from six to twenty-one days after an 
exposure to its contagion, it will be noticed that the 
patient has a spasmodic cough, which is accompanied by 
more or less fever and a peculiar "whoop" from which 
the disease takes its name. During the attacks of cough- 
ing the face becomes flushed, the eyes red and watery 
and, in severe cases, there is vomiting, especially after 
meals. Hemorrhage from the nose is quite frequent; 
and, in infants, there may be high fever, with either active 
or passive congestion of the brain, and convulsions. 

Bronchitis and pneumonia are the most frequent 
complications. An attack may be followed by dropsy of 
the brain, especially in young subjects, however, this is 
uncommon. 

Treatment: Control the fever with sedatives admin- 
istered according to indications, as in any other disease. 



i 3 4 THE PRACTICE OF MEDICINE. 

To control the cough give the following: 

Tr. of Lobelia, i drachm, 

Fl. Ext. of Ipecac, J drachm, 

Syrup of Wild Cherry, sufficient to make, . 4 ounces. 

Mix and give a teaspoonful every three hours. 

If there are convulsions administer the indicated 
" fever-drops " every half -hour until relief is obtained 
or until four or five doses are given. Keep the head cool 
and the feet warm; and, if necessary, give Hydrate of 
Chloral every half-hour until the convulsions are con- 
trolled. The proper dose of Chloral for a child is one 
grain for each year of age up to twenty. « 

When high fever is present keep the bowels open and 
the kidneys acting normally. 

Where other complications occur they must receive 
proper treatment. 

ACUTE BRONCHITIS. 

BRONCHIAL CATARRH. 

This is an acute, catarrhal inflammation of the mucous 
membrane of the bronchial tubes; characterized by fever, 
pain in the breast, more or less difficulty in breathing 
and a cough with, at first scanty expectoration, but later 
becoming profuse. 

It is quite common in children and the aged and not 
uncommon in those of middle-age. 

Its most frequent causes are cold, exposure, atmos- 
pherical changes and the inhalation of irritants such as 
dust, smoke, gases, vapors and air too hot or too cold. 



ACUTE BRONCHITIS. 135 

Symptoms: An attack usually commences with sym- 
toms of an ordinary cold, such as hoarseness, soreness of 
the throat, lassitude and pain in the limbs, followed by 
a sensation of chilliness and more or less fever, with tight- 
ness, pain and soreness in the upper part of the chest. 
The cough is at first hard, dry, tight and painful, but in 
the course of a few days the expectorated matter consists 
of a clear tenacious mucus, which gradually becomes 
yellowish or greenish and sometimes very profuse. During 
the latter part of severe attacks the material expector- 
ated becomes purulent. Finally the fever gives way 
and the only disagreeable symptoms that remain are 
extreme weakness and the cough, which is sometimes 
severe. 

The usual duration of an attack is from twelve to 
twenty days, but this period may be greatly prolonged 
by improper treatment or nursing. 

Where the smaller bronchial tubes are the seat of the 
inflammation it is called capillary bronchitis or broncho- 
pneumonia. This condition is quite common in whooping 
cough and the eruptive fevers, especially measles. It 
is also frequently met with in the very young, and also 
in the old and feeble. This form of the disease may be 
known by the high fever, increased difficulty in breath- 
ing with paroxysms, which almost amount to suffocation. 
The pulse becomes weak and rapid and the surface of 
the body cold and purplish from imperfect oxygenation 
of the blood. This form of disease frequently terminates 
fatally, especially in the very young and the aged. Pre- 



136 THE PRACTICE OF MEDICINE. 

ceding dissolution there is usually stupor, insensibility, 
coma, or in children perhaps convulsions. 

Treatment: Control the fever with sedatives ad- 
ministered according to indications. If the pulse is quick 
and full give Veratrum or Aconite; and if the face is 
flushed, the eyes bright and the pupils contracted, add 
Gelsemium, thus : 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half or 
two hours. 

With children and where the stomach is irritated give 
Aconite instead of the Veratrum, adding the Gelsemium, 
if indicated; but if the patient is drowsy, the pupils being 
too large, give Belladonna instead of the Gelsemium, 
thus: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half 
or two hours while there is fever. 

If the pulse is weak or irregular give Digitalis and 
Cactus, adding the Belladonna if indicated, thus: 

Fl. Ext. of Digitalis, .12 drops, 

Fl. Ext. of Cactus Grandiflorus, 24 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every two hours. 



ACUTE BRONCHITIS. 137 

If indicated, at the beginning of the attack, Calomel 
should be given as follows: 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, . .' 1 grain. 

Mix, divide into five powders and give one every 
hour. 

Should they fail to act mildly on the bowels give Oil, 
Salts or a Seidlitz Powder. 

The patient should have at least one action a day 
from the bowels throughout the attack. 

If the urine is scanty give 20 grains of the Acetate of 
Potash or 30 drops of the Fl. Ext. of Buchu every three 
or four hours until the desired . effects are obtained. 

Where the expectoration is watery, the face, hands 
and feet swollen or puffy (cedematous) the Fl. Ext. of 
Apocynum Cannabinum in 3 or 4-drop doses, every four 
hours, acts almost as a specific. In such cases it is the 
very best cough remedy known to the writer. 

Where the cough is dry and tight give the following: 

Tr. of Lobelia, 2 drachms, 

Fl. Ext. of Ipecac, 1 drachm, 

Syrup of Wild Cherry, to make, 4 ounces. 

Mix and give a teaspoonful every three or four 
hours. 

This may act as an emetic, especially where the stomach 
is sensitive. In such cases decrease the dose. 

Where the material expectorated is profuse give the 
following instead of the foregoing: 



138 THE PRACTICE OF MEDICINE. 

Chloride of Ammonia, 4 drachms, 

Fl. Ext. of Squill, 2 drachms, 

Fl. Ext. of Tolu, 1 ounce, 

Simple Syrup, sufficient to make,. . .4 ounces. 
Mix and give a teaspoonful every three or four hours. 

Where young children are suffering with capillary 
bronchitis and are threatened with suffocation from an 
accumulation of mucus in the bronchial tubes, emetics 
of \ to 1 drachm-doses of the Syrup of Ipecac may be 
given and repeated as demanded, however, care must 
be exercised not to keep the child continuously nauseated, 
nor to use the emetics to such an extent that they 
produce exhaustion. 

In cases where there is considerable weakness, stimu- 
lants, such as Whiskey or Aromatic Spirits of Ammonia, 
should be used every two or three hours, or oftener, if 
necessary, the quantity depending upon the age and the 
condition of the patient. Where there is great prostra- 
tion and feeble pulse it may become necessary to admin- 
ister from the 1-60 to the 1-40 of a grain of Strychnine 
every three or four hours. 

Care and judgment should be used in feeding and 
nursing the patient. 

CHRONIC BRONCHITIS. 
This is a chronic inflammation of the mucous mem- 
brane of the bronchial tubes; characterized by cough, 
more or less severe, and expectoration, in some cases 
scanty, while in others it is profuse, 



CHRONIC BRONCHITIS. 139 

It may follow repeated attacks of acute bronchitis 
or the repeated inhalations of dust, smoke or other irri- 
tants; but it is more commonly met with in gout, 
rheumatism, syphilis, aneurism of the aorta, lung, heart 
and kidney diseases and as a result of the excessive use 
of alcoholic liquors. It . rarely ever attacks the young, but 
is the winter cough of the old, recurring with regularity 
as the weather gets cold and changeable. 

Symptoms: Unlike the acute form of the disease, 
in this, there is little, if any, fever. Cough is one of its 
most prominent symptoms and is more troublesome 
during cold and changeable weather than at other 
times, many patients being almost or entirely free from 
it during warm weather. 

The disease may continue in this manner indefinitely 
without producing any serious results, where it is not 
associated with other diseases, however, it is generally 
more severe in character, the cough continuing through- 
out the year, being worse, as a general rule, after the 
slightest exposure or change in the atmosphere. It is 
usually more distressing during the night and early morn- 
ing. Slight pain is sometimes felt in the chest, especially 
after a paroxysm of coughing. The expectoration varies 
in different cases; in some, it consists of a viscid, whitish, 
mucus and in many cases it is profuse; in others, it is 
yellowish or greenish and sometimes streaked with blood. 

In some cases the skin is dry and harsh, the appetite 
poor, the bowels irregular, the urine high-colored and 
the tongue coated. As the disease progresses the pulse 



Ho THE PRACTICE OF MEDICINE. 

becomes quick and weak; there is shortness of breath 
and the patient grows weaker day by day. 

The patient finally suffers more or less with night- 
sweats; there is hollo wness of the eyes and the material 
expectorated becomes more profuse, purulent, and some- 
times very offensive. The disease may continue in this 
manner until death closes the scene. 

The latter stage of severe cases presents many symp- 
toms in common with pulmonary tuberculosis from which 
it can only be satisfactorily determined by auscultation 
and percussion of the lungs and a microscopical exami- 
nation of the expectorated material. 

Treatment: Attention to the general health is of 
the first importance. Underlying chronic diseases must 
receive appropriate treatment. Flannel or silk under- 
clothing must be worn the year round and exposure of 
every kind must positively be prohibited. 

Where the patient is dibilitated, the appetite and 
digestion impaired, the following should be used: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Canadensis, 1 ounce, 

FL Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make, .6 ounces. 

Mix and give a teaspoonful before each regular meal. 

If the bowels are constipated give a sufficient amount 
of the Fl. Ext. of Cascara Sagrada after each regular meal 
to produce one average action a day from the bowels. 
From 10 to 30 drops is usually required. 



CHRONIC BRONCHITIS. 141 

Where there is scantiness of urine 20 grains of the 
Acetate of Potash or 20 to 30 drops of the Fl. Ext. of 
Buchu should be given three or four times a day. 

Where the skin is harsh and dry the entire body should 
be sponged with warm water and dried with consider- 
able friction before retiring each night. 

Should the cough be harsh and dry or the expectora- 
tion scanty the patient may be benefited by the nausea- 
ting expectorants, such as the following: 

Tr. of Lobelia, 1 J drachms, 

Fl. Ext. of Ipecac, 1 drachm, 

Syr. Wild Cherry, sufficient to make, . 4 ounces. 
Mix and give a teaspoonful every three or four hours. 
Should the cough be loose and the expectoration free 
or profuse stimulating expectorants should be given 
instead of the foregoing, as: 

Chloride of Ammonia, 4 drachms, 

FL Ext. of Squill, 2 drachms, 

Tr. of Tolu, 1 ounce, 

Simple Syrup, sufficient to make,.. 4 ounces. 
Mix and give a teaspoonful every three or four hours. 
In addition to the foregoing, where the expectoration is 
very profuse (bronchorrhcea) , the odor being offensive, 
20 to 30 drops of Carbolic Acid should be put into a half- 
pint of boiling water and the steam inhaled for a few 
minutes three or four times a day. 

Counter-irritants applied to the chest are very bene- 
ficial in all cases of chronic bronchitis and the Compound 
Tar Plaster is one of the best agents, known, for this 



142 THE PRACTICE OF MEDICINE. 

purpose. It should be warmed, spread on thick cloth 
or thin leather, applied and worn as long as it can be 
tolerated, when, it should be removed for a few days, 
then, applied again and thus continued. 

Where the patient is greatly debilitated an emulsion 
of Cod Liver Oil with Hypophosphites may be given. 

The diet must be of the most nutritious character; 
and the patient should take moderate exercise in the open 
air during pleasant weather. The moderate use of 
Whiskey is of decided benefit in some cases. A change 
of climate, especially during the winter, is of decided bene- 
fit and should be urged if the patient's circumstances 
will admit it. Where the bronchial secretions are scanty 
a warm, moist climate, as Florida, is preferable, whereas 
if there is profuse bronchial secretion a dry, warm cli- 
mate, as New Mexico, should be selected. 

ASTHMA. 

PHTHISIC. 

Asthma is a paroxysmal spasmodic contraction of 
the muscular layer surrounding the smaller bronchial 
tubes, probably associated with a rigid contraction of 
the diaphragm, together with more or less bronchial catarrh; 
characterized by attacks of difficult breathing and a 
cough with mucous expectoration. The disease is gener- 
ally believed to be of nervous origin and is undoubtedly, 
in many instances, hereditary, the patient's family hav- 
ing had either asthma, chorea or epilepsy. It is some 
times produced by a diseased condition of the nose. The 
inhalation of dust and vapors or the inhalation of 



ASTHMA. 143 

pollen from vegetation will sometimes bring on an 
attack. The latter is especially the case with what is 
known as hay asthma. 

The disease is more common in men than in women; 
in children and young adults than in middle-life or old 
age; and is more frequently met with in the wealthy than 
in the poor. It not infrequently occurs as a complica- 
tion of heart, lung or kidney-diseases. Death rarely, 
if ever, occurs from uncomplicated asthma, but frequent 
attacks sometimes produce emphysema or a heart-dis- 
ease that may terminate in dropsy and death. 

Symptoms: The first attack, as a general rule, 
comes on suddenly, but succeeding ones are usually pre- 
ceded by premonitory symptoms, such as cold, more or 
less tightness in the chest, slight impairment of digestion, 
or the passage of a greater quantity of urine than is 
natural, its being clear. With the exception of some 
or all of the symptoms just mentioned, the patient retires 
for the night feeling as well as usual. During the night, 
more commonly the after part, the patient is aroused 
from sleep by difficult breathing, which grows worse 
rapidly and is accompanied by wheezing and a tight cough. 
The face soon becomes flushed and if relief is not 
obtained it becomes bluish and the body covered with 
perspiration. The difficulty in breathing is so great that 
the patient rushes to the window or door or into the open 
air and either sits or stands leaning forward, thereby 
hoping to facilitate respiration, feeling as if death were 
his certain doom. The cough finally becomes looser, the 



144 THE PRACTICE OF MEDICINE. 

breathing easier and the paroxysm is soon at an end. 
A paroxysm may last only a few minutes or it may last 
for hours, while in rare cases, with slight remissions, it 
may continue indefinitely. 

Treatment: The first thing to be considered in 
the treatment of asthma is the relief of the paroxysm. 
For this purpose 10 grains of Chloral Hydrate, repeated 
every half-hour until relief is obtained or four or five doses 
are given, is very efficient. The hypodermic injection 
of from J to \ of a grain of the Sulphate of Morphine 
gives almost instantaneous relief. Care must be exer- 
cised in the administration of Chloral and Morphine not 
to allow the patient to become addicted to their use. 

From 4 to 6 drops of the Nitrite of Amyl inhaled 
from a napkin may bring speedy relief. Its use will fre- 
quently abort an impending attack. The free use of 
strong Coffee without sugar or cream is also beneficial. 
Hot Whiskey in the form of a toddy sometimes affords 
marked relief. The hypodermic administration of 3 
grains of the Citrate of Caffeine will frequently afford 
prompt relief. The following is highly recommended: 

Nitrate of Soda, 24 grains, 

Water, 1 ounce. 

Mix and give a half-teaspoonful every half-hour until 
relief is obtained or until three doses are taken. 

The Tr. of Lobelia in half-teaspoonful doses every 
few minutes until relief is obtained or nausea produced 
is usually efficient. 



ASTHMA. 145 

The inhalation of the fumes of blotting paper that 
has previously been saturated with a concentrated solu- 
tion of Saltpeter, then dried and burned, is some- 
times very efficient in relieving a paroxysm. If it is 
used the atmosphere of the patient's room should be 
well rilled with the fumes. 

The leaves of Belladonna, Lobelia and Stramonium, 
when dried and then steeped in a strong solution of the 
Nitrate of Potash and then smoked, frequently affords 
relief. The inhalation of Chloroform or Ether is also 
efficient, however, great care must be exercised in the 
use of them. 

With a view of making a permanent cure the follow- 
ing should be given: 

Iodide of Potash, 1 ounce, 

Fl. Ext. of Grindelia Robusta, 2 ounces, 

Co. Syr. Stillingia, sufficient to make, 6 ounces. 

Mix and give a teaspoonful after each regular meal, 
continuing its use, if necessary, for months. Should this 
fail the following may be tried: 

Fl. Ext. of Grindelia Robusta, 2 ounces, 

Fl. Ext. of Lobelia, 4 drachms, 

FL Ext. of Sanguinaria, 4 drachms, 

FL Ext. of Senega, 1 ounce, 

Fl. Ext. of Skunk Cabbage, 1 ounce, 

Chloroform, 1 ounce. 

Mix and give a teaspoonful, in sweetened water, every 
fifteen to thirty-minutes until the paroxysm is relieved, 



146 THE PRACTICE OF MEDICINE. 

then, with a view of making a permanent cure, give it 
three or four times a day. 

The general health of the patient must receive care- 
ful attention; all diseased conditions must receive appro- 
priate treatment; and the stomach, bowels and kidneys 
kept, if possible, in a normal condition. 

A change of climate will sometimes effect a cure where 
every thing else fails. If financially able, asthmatics 
should continue the search until the proper climate is 
found. 

PNEUMONIA. 

WINTER-FEVER, LUNG FEVER. 

Pneumonia is an inflammation of the parenchyma, 
or substance, of the lungs; characterized by a marked 
chill, fever, headache, pain in the affected side, oppressed 
breathing and a cough with expectoration, first of a frothy 
mucus, soon becoming opaque and afterwards rusty. 

Standard writers tell us that it is caused by the micro- 
coccus lanceolatus of Frankel and that the disease is 
infectious, however, exposure to cold and wounds of the 
chest or lungs, by lowering vitality, or resisting power, 
predisposes to an attack. Those who use alcoholic liquors 
to excess are more subject to it than others. Men are 
more subject to it than women. One attack predisposes 
to another. Endemics and even epidemics of it occur. 
It may be croupous or catarrhal. The catarrhal form is 
known as capillary bronchitis. Where only a part of 
a lung is attacked it is called circumscribed or lobar pneu- 
monia; where one entire lung is affected it is called single 



PNEUMONIA. 147 

pneumonia, and where both lungs are involved it is called 
double pneumonia. 

Symptoms: An attack may be preceded, for a day 
or two, by a feeling of languor and dullness, headache, 
loss of appetite, pain in the limbs and back, a quick, 
short, hacking cough, shortness of breath, with chilli- 
ness and more or less coldness of the extremities; but in 
the majority of cases it is ushered in abruptly with a well- 
marked chill, continuing one or two hours, and children 
may have convulsions. The symptoms mentioned above 
are at this time aggravated and the cough is dry and sup- 
pressed. The chill finally gives way, fever follows, the 
temperature usually reaching 103 to 105 degrees; the 
pulse is quick, full and strong, and the skin hot and dry. 
There is severe pain in the back and head; white coated 
tongue; constipated bowels and scanty high-colored urine, 
and a dull pain in the region of the nipple of the affected 
side, which is aggravated by breathing, coughing, or pres- 
sure, and it will be noticed that the patient prefers 
to lie on the affected side, or, if both lungs are involved, 
upon the back. Respiration is now hurried and imper- 
fect and attended with unusual elevation of the shoulders 
and chest during each effort at inspiration. The cough, 
at first, is attended by the expectoration of a thin, frothy 
mucus, which soon becomes semi-transparent and so 
tenacious that the vessel containing it may be inverted 
without pouring it out. If the lungs at this stage are 
percussed, over the region involved, more or less dull- 
ness will be detected and this increases as the lung 



i 4 8 THE PRACTICE OF MEDICINE. 

becomes more hepatized (liver-like); and if the ear is 
applied to the chest, over the region where the dullness 
is detected, a minute crackling sound will be heard, 
resembling the sound made by throwing fine salt on 
live coals of fire, or the rubbing of hair between the 
fingers. In order to detect these sounds, as described, 
have the patient, while the ear is applied to his chest, 
take a few full inspirations. By the second or third 
day the material expectorated becomes rusty and more 
profuse, having the appearance of brick-dust. 

The foregoing symptoms, with the exception of 
the pulse, which, towards the latter part of the attack, 
becomes quick and weak, or irregular, continue about 
the same until the fifth to the seventh day, when, in 
favorable cases the fever gives way and convalescence is 
established, the patient being greatly debilitated. As 
the fever gives way there is almost always profuse 
perspiratiori, a weak, irregular pulse and extreme weak- 
ness. 

Typhoid Pneumonia : This is pneumonia attended 
by the symptoms of typhoid fever such as severe pros- 
tration, nervousness, more or less delirium and the 
accumulation of sordes on the lips and teeth, the tongue's 
being red and dry. This condition may be present from 
the beginning of the attack, but more commonly the 

attack begins as an ordinary pneumonia, and this form 

- 

is assumed after the first few days. 

Pleuro-Pneumonia : This is pneumonia compli- 
cated with an inflammation of the pleura, a membrane 



PNEUMONIA. 149 

consisting of the covering of the lungs and lining the 
inner surface of the walls of the thorax. In these 
cases the breathing becomes more difficult, the pain more 
severe and of a sharp cutting character. See Pleurisy. 
Treatment: Every drop of blood that circu- 
lates in the body goes directly from the heart into 
the lungs and from the lungs back to the heart and 
then to the various parts of the body when it is again 
returned to the heart and then to the lungs. Now, 
bear in mind that pneumonia is an inflammation 
of the substance of the lungs; then, is it not reason 
and common sense that if the heart's action is con- 
trolled, thereby lessening the amount of blood thrown 
into the inflamed lung-tissue and thus giving it rest, 
that the pain and engorgement to a great extent, 
will be controlled and the patient's chances for recovery 
greatly enhanced? We care nothing about the cause, 
whether it be germs, cold, or something else, what 
we have to contend with is the effect of a cause 
and this effect is inflamed lung-tissue. The old 
method of treating pneumonia was by bleeding and 
active cathartics, which is bleeding indirectly. Both 
are very exhausting, and were it not for this fact 
bleeding, directly, would yet be our very best treat- 
ment for pneumonia; but as the great majority of 
persons, who die with this disease die from weak- 
ness, all exhausting remedies or measures must be 
shunned as we would death itself. Bleeding relieved 
the inflamed lung-tissue by lessening the amount of 



150 THE PRACTICE OF MEDICINE. 

blood thrown to it. Now, we have remedies that 
will do the very same thing and not impair or destroy 
one drop of • blood in the system, besides their effects 
may be discontinued or even counteracted whenever 
it is necessary. We refer to Aconite and Veratrum. 

The authors of this work have practiced medicine 
almost an average life-time, and we hope the reader 
will pardon us when we say that we are absolutely 
proud of our records in this disease, and these reme- 
dies have been our sheet-anchor. As much as pneu- 
monia is dreaded, its tendency, even without treat- 
ment, is to recovery. 

If the pulse is too quick and too full, and the stomach 
not irritated, give Veratrum, and if there is flushed 
face with bright eyes and contracted pupils, add Gei- 
semium, also add small doses of Ipecac and Lobelia 
for the cough, thus: 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, .27 drops, 

Fl. Ext. of Ipecac, 18 drops, 

Tr. of Lobelia, 36 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a 
half while the pulse is too full and too quick. If 
the stomach is irritated give Aconite instead of the 
Veratrum, adding the other remedies. The dose of 
the Tr. of Aconite in this, as well as other diseases, 
is one drop. 



PNEUMONIA. 151 

If the patient is drowsy, the pupils being too large, 
Belladonna should be used instead of the Gelsemium, 
as follows: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Fl. Ext. of Ipecac, 18 drops, 

Tr. of Lobelia, 36 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half 
while the pulse is too quick and too strong. In addi- 
tion to the Veratrum or Aconite, where the fever is high, 
the skin dry and the pulse strong and the patient 
not drowsy, from 3 to 5 grains of Acetanilide, should 
be given every three or four hours. 

At the commencement of the attack if it is indi- 
cated, and it is usually, Calomel should be given, thus: 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, 1 grain. 

Mix and divide into five powders and give one every 
hour. If they fail to act mildly on the bowels give 
Oil, Salts or Seidlitz Powders. 

The patient should have at least one action from 
the bowels each day. Where the bowels fail to act 
this often, Oil, Salts or Seidlitz Powders may be given. 
Watch the action of the kidneys. If the flow 
of urine is scanty give 20 grains of the Acetate of 
Potash , or 20 to 30 drops of the Fl. Ext. of Buchu, 
every three or four hours as is necessary. 



152 THE PRACTICE OF MEDICINE., 

Where the fever is distinctly periodic, though in no 
other case, 4 or 5 grains of Quinine should be given every 
two hours during the remission. 

Where the tongue is broad, pallid and uniformly 
coated with a filthy, whitish material, 20 grains of 
the Sulphite of Soda should be given every three or 
four hours until the tongue is clean or its color 
changed. 

Where the tongue and mucous membrane are 
red, or red and dry, 3 drops of Hydrochloric acid 
should be given, in a half a glass of water, every 
four hours. Should the skin and eyes become yellow 
give from 20 to 30 drops of the Fl. Ext. of Chio- 
nanthus every four hours until every trace of yellowness 
has disappeared. 

Where the pulse becomes weak or irregular or when 
it is in this condition from the beginning of the attack, 
Digitalis and Cactus should be given instead of the 
Veratrum or Aconite, adding the Lobelia and Ipecac for 
the cough, thus: 

Fl. Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus, Grandiflorus, . . 24 drops, 

Fl. Ext. of Ipecac, 12 drops, 

Tr. of Lobelia, 24 drops, 

Water, 12 teaspoonfuls. 

Mix and give a teaspoonful every two hours until 
the pulse becomes normal. If the patient is drowsy, 
the pupils being too large, or where there is profuse 
perspiration J of a drop of the Fl. Ext. of Bella- 



PNEUMONIA 153 

donna should be added to each dose of the fore- 
going. If the pulse is very weak 1-40 of a grain 
of the Nitrate or Sulphate of Strychnine, or 1-100 
of a grain of Nitroglycerine, should be given every 
three or four hours. From 20 to 30 drops of the 
Aromatic Spirits of Ammonia, given in a sup of water, 
every two or three hours is also a valuable stimulant 
in these cases. The use of Whiskey should not be 
neglected when the pulse is weak. The amount to 
be given must be determined by its effects on the 
heart. A few ounces during each twenty-four hours, 
will answer in some cases, while others may require 
ten or twelve ounces. It is best given in the form 
of egg-nog or milk-punch, however, the tastes of the 
patient may be considered. 

The application of a small bag of hot salt to the 
affected side is usually all that is required for the 
relief of pain. The salt, when used, should be changed 
sufficiently often to prevent its becoming cool. Where 
the pain is very severe from 3 to 8 grains of Dover's 
Powder may be given every four or six hours, how- 
ever, no more of it should be used than is actually 
necessary. 

Where there is delirium, nervousness, or an inability 
to sleep, 10 grains of the Hydrate of Chloral should 
be given every half-hour or hour until sleep is pro- 
duced or three or four doses are given. 

Typhoid pneumonia requires no special treatment 
more than has already been outlined. See Pleurisy. 



154 THE PRACTICE OF MEDICINE. 

The temperature of the sick-room should be kept 
between 65 and 70 degrees Fahr. The diet should 
consist of such articles as milk, eggs, crackers, gruel 
and soups, however, tea and coffee may be allowed. 

PLEURISY. 

PLEURITIS. 

Pleurisy is an inflammation of the serous mem- 
brane covering the lungs and lining the inner thoracic 
wall; characterized by a chill, fever, cutting pain in 
the side, difficult breathing and a dry cough. The 
inflammation may be acute or chronic, local or general, 
but is usually confined to one side. 

It is caused by various micro-organisms or their 
irritating chemical products. Cold and exposure and 
injuries to the chest-wall are important predisposing 
causes. It is frequently associated with pneumonia, 
rheumatism, bronchitis, small-pox and tuberculosis. It 
occurs in both sexes and in all climates. 

Symptoms: An acute attack usually commences 
with a well-marked chill, followed by fever, thirst, 
quickened pulse, restlessness and a severe cutting pain 
in the side or chest, aggravated by breathing, cough- 
ing or lying on the affected side. The breathing, 
which is rapid and shallow, is carried on principally 
by the diaphragm and abdominal muscles. The pulse 
is usually full and quick, and the cough dry, short 
and hacking. The fever, with the exception of slight 
remissions of mornings, is continuous. The bowels are 
constipated, the skin hot and dry and the urine scanty 



PLEURISY. 155 

and high-colored. During this stage of the disease if 

the ear is applied to the chest over the affected region 

a slight creaking sound resembling that made by new 
leather may usually be heard. 

Within a few days effusion occurs, when, the 
fever and pain subside to some extent, but the breath- 
ing, at this time, becomes more difficult, the cough 
more distressing and the pulse weak or irregular and 
the patient usually lies on the affected side. The 
effusion is so great in some cases that there is a 
protrusion of the skin between the ribs. Where 
both sides are involved, and the effusion profuse, death 
may occur from suffocation unless the fluid is promptly 
removed. With the absorption of the fluid the patient 
improves and convalescence is more or less rapid. In 
some cases the absorption of the fluid is slow and in 
these cases the patient may finally die of exhaustion. 

In the chronic variety of the disease, or where the 
effusion is purulent, the patient is emaciated, there is 
loss of appetite, irregular chills, more or less fever, night- 
sweats, pains in the chest, difficult breathing and a dry 
hacking cough, which may, in some cases, be attended 
by the expectoration of a small amount of mucus. See 
Septicaemia. 

Treatment: Control the fever with the indicated 
sedatives and, in addition to these, where the fever is high, 
the pulse full and strong and the skin dry, give from 3 
to 5 grains of Acetanilide every three or four hours. If 



156 THE PRACTICE OF MEDICINE. 

it is indicated, and it usually is in these cases, give Cal- 
omel as follows: 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, 1 grain. 

Mix and divide into five powders and give one every 
hour. If they fail to act on the bowels give Salts. The 
Improved Compound Cathartic Pills may be used if pre- 
ferred, instead of the Calomel. The dose of them is two 
pills; give one and in an hour give the other one. 
The bowels should be kept open throughout the attack. 
For this purpose give Salts, when necessary. 

Apply a small bag of hot salt to the painful region, 
changing it sufficiently often to prevent its becoming 
cool. 

If the fever is periodic, but in no other case, give 
5 grains of the Sulphate of Quinine every two hours 
during the remission, however, where the fever remains 
down after four doses are given, then administer it 
every three or four hours. 

When the fever begins to subside give 20 grains 
of the Acetate of Potash every three or four hours 
until absorption is completed. 

Where the effusion is so great that suffocation is 
threatened it must be removed at once. This may be 
accomplished with an aspirator. The needle should 
be inserted between the fifth and sixth ribs. 

Where the disease assumes the chronic form apply 
a Compound Tar Plaster over the region involved 



PLEURISY. 157 

letting it remain as long as the .patient can bear it, 
when, it • should be removed until the irritation pro- 
duced by it has subsided to some extent, when it 
must be applied again and thus continued until the 
patient completely recovers. 

The absorption of the effused fluid may be promoted 
by the following: 

Iodide of Potash, .1 ounce, 

Compound Syr. of Stillingia, sufficient 

to make, 6 ounces. 

Mix and give a teaspoonful after each regular meal. 

Should the fluid in the pleural cavity consist of pus 
(empyema), and this may be known by the irregular 
chills, fever, night-sweats, etc., it must be removed at 
once. This may be accomplished by making an incision 
into the pleural cavity, about an inch long, between 
the fifth and sixth ribs and then washing the cavity 
out with the following: 

Permanganate of Potash, 4 grains, 

Water, 1 pint. 

Mix and inject into the pleural cavity with an 
ordinary syringe. The water must be boiled and 
then strained into a sterilized china-ware vessel before 
adding the Potash. It should be used warm. After 
washing out the cavity insert a soft rubber drainage 
tube and hold it in place with a bandage and a 
safety-pin. This precaution is necessary to prevent 
the tube's coming out or slipping into the pleural 



158 THE PRACTICE OF MEDICINE. 

cavity. The wash may be used once a week until 
pus is no longer formed in the cavity. 

When the fever subsides the following tonic should 
be given until the patient's former strength is regained: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fowler's Solution of Arsenic, 1 J drachms, 

Aromatic Elixir, sufficient to make, . 6 ounces. 
Mix and give a teaspoonful before each regular meal. 
The diet in these cases should consist of such articles 
as bread, milk, oysters, soft-boiled eggs, beef-essence, 
soups and boiled meats. 

HEMOPTYSIS. 

HEMORRHAGE OF THE LUNGS. 

Haemoptysis is the expectoration of pure or unmixed 
blood of a bright-red color from the lungs usually 
by coughing. 

It is caused in a majority of cases by pulmonary 
tuberculosis, however, it may result from excessive 
action of the heart, congestion of the bronchial tubes, 
excessive exertion as straining, lifting, jumping, running, 
etc. The hemorrhage itself rarely produces death 
except where it is the result of heart-disease, or the 
rupture of the aorta. 

Symptoms: Hemorrhage from the lungs in a great 
majority of cases is preceded by evidences of impaired 
health. There is usually a sensation of warmth 
and oppression in the chest, and tickling in the throat; 
or there is, in rare instances, palpitation of the heart, 



HAEMOPTYSIS. 159 

slight difficulty in breathing, with dizziness. Upon 
coughing the patient's mouth is filled with bright, 
red, frothy blood or if the hemorrhage is profuse the 
blood is raised without coughing. The patient's alarm, 
which is great from the beginning of the attack, is 
usually increased by the excitement of friends, and 
this assists in causing the extreme prostration seen 
in such cases. The attack may last from a few 
minutes to as many hours; the amount of blood lost 
varying from a few drops to as many pounds, how- 
ever, the average quantity being from an ounce to a 
pint. In rare cases from a few drops to a table- 
spoonful of blood may be expectorated occasionally 
for several days and then, gradually cease. 

Treatment: The patient should be put to bed in 
a well- ventilated room, the head and shoulders elevated, 
all excitement avoided and Ergot and Rhus Aromat- 
ica given, thus: 

Fl. Ext. of Ergot, 4 drachms, 

Fl. Ext. of Rhus Aromatica, 4 drachms. 

Mix and give from twenty to sixty drops every 
twenty or thirty minutes until the patient is relieved. 
Should the foregoing not be at hand give common 
Salt (Chloride of Sodium) freely. If the feet are 
cold bathe them in warm water and apply heat to 
them. 

Where the hemorrhage is caused by excessive action 
of the heart, which is indicated by a strong, full 
pulse, give one drop of the Tr. of Veratrum Viride 



160 THE PRACTICE OF MEDICINE. 

every half-hour until relieved or the heart's action is 
reduced. After relief is obtained all active exercise 
must be avoided for a few days. 

EPISTAXIS. 

HEMORRHAGE OF THE NOSE. 

Epistaxis, or bleeding from the nose, may be from 
one or both nostrils and is so common that a description 
of it is thought to be unnecessary. All ages are subject 
to it. 

Treatment: Where the hemorrhage is slight no 
treatment is necessary, however, if there is danger on 
account of the loss of blood, apply cold water to the 
back of the neck, the forehead and nose and plug 
the bleeding nostril with cotton moistened with strong 
Alum-water, or a saturated solution of Tannin. The 
Alum- water, or solution of Tannin, may be injected 
into the nose. Monsell's Solution of Iron, slightly 
diluted, or even full strength, may be used in the 
same manner. 

Where the foregoing means fail, the posterior nares 
should be plugged with a soft piece of sponge or 
cotton, by means of a string fastened to it, which 
should be passed up through the nostril and drawn 
out through the mouth until the sponge or lint comes 
in contact with the bleeding surface. 

PHTHISIS PULMONALIS; TUBERCULOSIS. 

CONSUMPTION. 

Consumption or tuberculosis is an infectious disease; 
characterized by a progressive failure of the health 



PHTHISIS PULMONALIS; TUBERCULOSIS. 161 

fever, cough night-sweats, diarrhoea, difficult breathing, 
emaciation, exhaustion and usually death. There is 
a deposition in the lungs of morbid bodies of a yel- 
lowish, cheesey substance, called tubercles, which undergo 
ulceration and softening, degenerating into pus or an 
ichorous material destroying more or less lung-tissue, 
thus forming cavities and rendering the lungs incapable 
of performing their proper function. The deposit of 
tubercles usually occurs at one of the apices of 
the lungs. Deposits may also occur in the brain, 
liver, joints, intestines, lymphatic glands, mesentery, 
and, in fact, almost any organ or tissue of the body. 
This, however, is more common in children than in 
adults. 

The disease is caused by the bacillus tuberculosis, 
and is not confined to any age, however, it is more fre- 
quently developed between the ages of fifteen and thirty 
years. The principal remote cause of it being a 
weakened condition of the system, which favors the 
development of the bacillus, transmitted from the 
parent to the child. The disease is not infrequently 
acquired by persons, who are not thus predisposed. It 
is an undeniable fact that the husband has contracted 
the disease from the wife and the wife from the husband 
and instances of the spread of the disease in factories, 
prisons and the contraction of it by physicians, nurses 
and attendants, are not rare. The chief source of the 
bacillus is the expectorated material (sputum) of tuber- 
culous patients. In the advanced stage of the disease 



i62 THE PRACTICE OF MEDICINE. 

several billions of the bacilli are expectorated daily by 
each patient, and the dried sputum is wafted into the 
atmosphere in the form of dust-like particles contain- 
ing innumerable bacilli, thus furnishing abundant oppor- 
tunity everywhere for infection. The disease is not 
uncommon in cattle and man may be infected through 
the milk of diseased animals. 

Symptoms: In the. first, or incipient stage, there is 
an impairment of the general health; more or less 
indigestion; some difficulty in breathing, perhaps 
amounting to a shortness of breath, more especially 
on taking exercise. Cough is usually a very early 
symptom; it may be slight and hacking at first, but 
gradually becomes more and more distressing and 
frequent; at first it is dry, but is soon attended by 
an expectoration of a thin frothy character, or it may 
resemble mucus, and is not infrequently streaked with 
blood. In some cases the first observable symptom 
is a more or less profuse hemorrhage from the lungs. 
Slight, transient pains are felt in various parts of the 
chest; slight depressions, just below the collar bones, 
are sometimes present; the hair looks dry and dead; 
the nails curve inwards and a red line may appear 
near the margin of the gums. As the disease advances 
the breathing becomes more difficult; the cough 
more severe and distressing; the skin hot and dry 
with burning sensations in the palms of the hands 
and soles of the feet. The appetite is variable and 
capricious; the bowels irregular; the urine turbid; the 



PHTHISIS PULMONALIS; TUBERCULOSIS. 163 

pulse quicker than usual; the tongue clean, or furred, 
white in the center and red at its tip and edges, 
and night-sweats are met with even in this stage of 
the disease. The fever is usually of a remittent 
character, the remission occurring towards evening. In 
some cases, there are two exacerbations of the fever 
daily; one about noon and the other during the night, 
usually terminating in profuse perspiration. These 
symptoms vary with different patients, according to 
the extent of the disease and the several modifying 
circumstances to which patients are exposed. 

In the second stage of the disease the expectora- 
tion contains small cheese-like particles of a light- 
yellowish color, owing to softening of the tubercles. 
The cough increases in severity and is more frequent; 
breathing is more hurried and difficult; chilly sensa- 
tions, which were felt in the first stage, now amount 
to actual chills. These occur usually in the latter 
part of the day and are followed by fever and pro- 
fuse, morning perspiration. Towards evening the face 
is usually flushed; the pulse rapid; the appetite fails; 
the features are sharp; there is a sense of constric- 
tion in the chest; debility and emaciation are now 
prominent symptoms and deep inhalations or a fit of 
coughing frequently induce more or less pain in the 
chest. Hemorrhage from the lungs, owing to the 
erosion of small blood vessels by ulceration, is com- 
mon in this stage. It should be remembered, how- 
ever, that hemorrhage from the lungs is not a posi- 



164 THE PRACTICE OF MEDICINE. 

tive sign of consumption as it occasionally occurs as 
an independent affection. In many cases an obstinate 
and debilitating diarrhoea occurs, which assists still 
further to weaken the patient. Pains in the bowels, 
irregular chills, hectic fever, thirst and night-sweats, 
are very common, but, as in the first stage, all the 
symptoms vary in different individuals. 

In the third stage, all the preceding symptoms are 
aggravated; the breathing is short and hurried; the 
pulse rapid; the cough almost constant and very dis- 
tressing; the voice weak and hoarse; the expectora- 
tion purulent and the emaciation and debility very 
much increased. The feet and ankles swell; diar- 
rhoea continues obstinate and unyielding; and a few 
weeks before dissolution the mouth is attacked with 
aphthous ulceration, and in rare instances there is 
delirium. More generally, however, the senses remain 
to the end not much impaired, and a characteristic 
symptom of the disease is that those afflicted with it 
are seldom apprehensive of danger, but flatter them- 
selves with a speedy recovery. 

In the last stage, the difficulty in breathing is 
often excessive; the voice sinks to a whisper; bed- 
sores form and add much to the suffering. Death 
may occur in several ways; from debility, the most 
common; from peritonitis, brought on by ulceration of 
the bowels; from congestion of the lungs; from hae- 
moptysis; or from an accumulation of air in the pleu- 
ral cavity. 



PHTHISIS PULMONALIS; TUBERCULOSIS. 165 

Treatment: Can pulmonary tuberculosis in any 
of its stages be cured? With due respect for those 
who claim to the contrary, experience teaches us to 
answer, emphatically no. As the disease, when once 
established, is incurable, every precaution should be 
used to avoid its contraction. Any one, however 
robust, may contract the disease. Our greatest dan- 
ger is from the expectoration of those afflicted with 
it. Consumptives should never expectorate except into 
some receptacle, which should be carried with them 
wherever they go, and the sputum burned or boiled 
before being thrown out. Patients should be thor- 
oughly instructed as to the necessity of this precau- 
tion, as the observance of it, in all probability, will 
save near and dear friends from rilling untimely graves 
from the effects of this most terrible malady. Per- 
sons predisposed to or afflicted with the disease should 
spend as much time as possible, during good weather, 
in the open air, and their sleeping apartments must 
be well ventilated. Sudden changes in temperature, 
hot, crowded rooms, and all other influences that 
are liable to impair the general health, must be studi- 
ously avoided; and persons afflicted with the disease 
should be instructed to avoid the swallowing of their 
sputum. Children born of consumptive or scrofulous 
mothers should be supplied with a healthy wet-nurse, 
or if this is impossible, the fresh milk of a healthy 
cow is our best substitute for the mother's milk. 
See Care of the Infant. Those predisposed to the 



166 THE PRACTICE OF MEDICINE. 

disease should have 'the greatest possible care taken 
of them and appropriate tonics administered during 
convalescence from acute diseases; and any impair- 
ment of the general health must be promptly rem- 
edied. No one, under - any circumstances, should 
sleep in the room with a consumptive. 

A change of climate is of the greatest prophylactic 
importance to children or others, who are predisposed 
to, or afflicted with the disease. Let them be 
removed from the city to the country or to the moun- 
tains. It should be borne in mind, however, that 
that there is no specific influence in any climate. 
Observation shows that different climates are suited 
to different persons. The advantages belonging to 
climate are altitude, uniformity and dryness. A dry 
climate is usually preferable, but some patients do 
better in a warm, humid atmosphere. With respect 
to temperature, a uniform, cold climate is better for 
some patients, and a uniform, warm climate for others. 
In selecting a climate the choice and feelings of the 
patient should have considerable weight. If, when 
in health, more vigor and enjoyment is experienced 
in summer than in winter, then, a warm climate 
will probably be better, and, if the reverse is true, a 
cold climate should be chosen. 

The place selected should contain resources for 
occupation and mental interest; and as much time as 
possible should be spent in the open air; however 
this must be postponed when the patient has fever. 



PHTHISIS PULMONALIS; TUBERCULOSIS. 167 

When a place become tiresome it is best to re- 
move the patient from it. Patients, who are depend- 
ent on the association of friends for their happiness 
are not likely to be benefited by being sent away, 
especially if alone and among strangers. It is cruelty 
to send to a distance, patients who are in a con 
dition admitting of but little prospect of improve- 
ment, and, who will probably never live to return. 

The diet of consumptives and those predisposed 
to it should be of the must nutritious character, con- 
sisting of such articles as soups, milk, butter, eggs, 
beef, pork, mutton, fish, fowl, fresh vegetables, cereals 
and fruits. Coffee and tea may be allowed in mod- 
erate quantities. 

By wearing flannel the entire year and adopting 
the methods here outlined the disease may be avoided 
to a great extent and the lives of those who are 
suffering with it in its incipient stage may be greatly 
prolonged 

Control the fever with sedatives, administered accord- 
ing to indications, in this as in any other disease. If the 
fever is high and the pulse full and strong from three to 
five grains of Acetanilide may be given every three or 
four hours. The daily tepid bath, followed by brisk 
friction with a coarse towel, is very beneficial, especially 
while the patient is having fever. 

Where there is debility and loss of appetite, give the 
following : 



i68 THE PRACTICE OF MEDICINE. 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Fowler's Solution of Arsenic, 1 \ drachms, 

Aromatic Elixir, sufficient to make, .6 ounces. 
Mix and give a teaspoonful before each regular meal. 
The only objection to this prescription is its bitter taste; 
this, however, may be avoided by having the remedies 
put into sugar-coated tablets. When this is done the 
Aromatic Elixir should be omitted. 

Cod Liver Oil, in teaspoonful-doses, three or four 
times a day in the absence of fever, and where it does not 
disagree with the stomach, is highly extolled, but it cer- 
tainly possesses very little, if any, value as a remedy, and 
as a food it is far inferior to good, fresh, sweet 
cream or unskimmed milk. 

The Syrup of the Hypophosphites of Lime, Soda 
and Potassium, of the U. S. P., is a very good tonic 
in these cases and may be given in doses of from 
one to four teaspoonfuls three or four times a day, 
however, it will be found inferior to the tonic pre- 
viously mentioned. 

Where digestion is feeble the following should be 
given : 

Pure Pepsin, 10 grains, 

Pancreatin, 10 grains. 

Mix and give at one dose after each meal. 
Cough is a very troublesome symptom in con- 
sumption, but does not demand special treatment 



PHTHISIS PULMONALIS; TUBERCULOSIS. 169 

unless it is so severe that it produces vomiting or 
prevents the patient from procuring the required 
amount of sleep. Where the cough is dry the follow- 
ing should be used; 

Chloroform, .-."..,.... „ \ drachm, 

Creosote, .......:,..., „..,. = . \\ drachms, 

Terebene, . . \\ drachms, 

Eucalyptol, 1 drachm, . 

Alcohol, sufficient to make, 1 ounce. 

Mix and inhale from 10 to 20 drops of it, by 
means of an inhaler, several times a day, as is 
required, to control the cough. A bath in warm water, 
the temperature being about 100 degrees Fahr., after 
which, drying the patient with considerable friction, and 
requiring him to remain perfectly quiet for a few hours 
is also highly recommended and should be given a trial. 
Should the foregoing means fail to control the cough, 
or where it is loose, the following should be used: 

Sulphate of Codeine, 8 grains, 

Dilute Hydrocyanic Acid, 48 drops, 

Syrup of Tolu, 3 ounces. 

Mix and give a teaspoonful every four hours as is 
required. 
Or: 

Chloride of Ammonia, 3 drachms, 

Whiskey, 4 drachms, 

Glycerine, 4 drachms, 

Paregoric, 1 ounce, 



170 THE PRACTICE OF MEDICINE. 

Chloroform-Water, i ounce, 

Syrup of Wild Cherry, sufficient to 

make, 6 ounces. 

Mix and give a teaspoonful every three or four hours 
as is required. Should the foregoing means fail to con- 
trol- the cough the Sulphate of Morphine will have to be 
given. The dose should not be larger than is required 
to give rest. 

Nauseating expectorants should not, under any cir- 
cumstances, be administered to consumptive patients 
as they interfere with digestion, thereby doing a great 
deal more harm than good. 

For the hectic fever and night-sweats give Quinine 
and an infusion of common Sage. Should these fail 
to afford relief give 15 or 20 drops of the Aromatic Sul- 
phuric Acid, well diluted with water, three or four 
times a day. The Oxide of Zinc in 2 -grain doses, 
three times a day is very efficient in these cases. 
The Sulphate of Atropine in 1-60-grain doses, or 
Agaricine in 1-20-grain doses at bed-time is also 
efficient. 

Diarrhoea, when present, may usually be con- 
trolled with such remedies as the Subnitrate of Bis- 
muth, Tannin, Bayberry and the Fl. Ext. of Pinus 
Canadensis. The following is also valuable in these 
cases : 

Sugar of Lead, 18 grains, 

Gum Opium, 3 grains. 



EMPHYSEMA. 171 

Mix and put into six capsules and give one every 
four to six hours as is required to control the bowels. 

Whiskey, if it does not disagree with the patient, 
may be used in any stage of the disease, and is a 
very beneficial remedy in some cases. 

EMPHYSEMA. 

Emphysema is a rupture or enlargement of the 
air-cells of the lungs; characterized by enlargement 
of the chest, difficult breathing with prolonged 
expiration and finally blueness of the surface and 
dilatation of the heart. There are two forms of the 
disease recognized; interlobular and vesicular. In the 
first there is a rupture of the air-cells; and, in the 
latter there is a dilatation or over-distention of the 
air-cells with enlargement of the lungs. 

Its most common causes are wounds of the chest, 
over-exertion, whooping-cough, bronchitis, asthma and 
the blowing of wind-instruments. The remote cause 
of it is a hereditary weakness of the lung-tissue. 

Symptoms: Difficult breathing is one of its lead- 
ing symptoms and is greatly aggravated by active 
exercise. In health, expiration is much shorter than 
inspiration. In emphysema this is reversed, expira- 
tion being much longer than inspiration. There is 
enlargement of the chest, increased resonance on per- 
cussion and in severe cases more or less blueness of 
the lips and skin, caused by an impeded circulation 
of the blood, thereby preventing a proper oxygenation 



i;2 THE PRACTICE OF MEDICINE. 

of this fluid. Emphysema is usually associated with 
some other disease as bronchitis, asthma, etc. 

Treatment: The disease is incurable, therefore, 
all that can be done is to adopt appropriate treat- 
ment for the various complications. See Bronchitis, 
Asthma, Dilatation of the Heart, and Dropsy. 



PART IV. 

DISEASES OF THE CIRCULATORY . SYSTEM. 

The circulatory system consists of the heart, peri- 
cardium, endocardium, arteries, capillaries and veins. 

PERICARDITIS. 

Pericarditis is an inflammation of the membrane 
containing or surrounding the heart; characterized by 
fever, pain, anxiety, a sensation of suffocation and 
more or less disturbance of the heart's action. 

The inflammation may be primary or secondary, 
acute or chronic. 

When it occurs as a primary disease it is usually 
the result of injuries to the chest- wall or cold and 
exposure. 

When it occurs as a secondary disease it follows 
or is associated with rheumatism, tonsillitis, la grippe, 
scarlet fever, small-pox, diphtheria, measles, puerperal 
fever, tuberculosis, septicaemia, Bright's disease, gout, 
scurvey, or diabetes; and in alcoholics it is not 
infrequently associated with pneumonia and pleuro- 
pneumonia. 

Symptoms: An attack usually commences with a 
well-marked chill, which is followed by fever of a 

173 



1^4 THE PRACTICE OF MEDICINE. 

remittent type. The pulse, in most cases, is quick, 
full and strong; the skin hot but usually moist; the 
bowels constipated and the urine scanty and high- 
colored. There is acute, shooting pains in the region 
of the heart, which is aggravated by breathing, cough- 
ing, pressure or lying on the left side. 

In some cases, more especially those of a chronic 
character, there is pain in the left shoulder some- 
times extending down the arm to the elbow or wrist. 
There is slight cough, more or less difficulty in breath- 
ing and a feeling of oppression and anxiety. 

When effusion occurs, which may be any time 
between the first and fourth days, there is increased 
dullness on percussion over the region of the heart, a 
diminution in the heart-sound, quick, weak, or irregu- 
lar pulse, great difficulty in breathing, more or less 
delirium, a tendency to syncope, hiccough and some- 
times vomiting. Absorption, is usually rapid, but the 
heart remains irritable for a long time. Should absorp- 
tion not occur, the fluid accumulates and where life 
is not destroyed the pericardial sack becomes dilated 
and chronic pericarditis follows. An attack of the 
disease occurring as a secondary affection presents no 
marked symptoms other than those just mentioned. 

Treatment: This should be commenced by the 
administration of sedatives according to indications. 
Where the pulse is full and strong and the stomach 
hot irritated give Veratrum and if there is flushed 



PERICARDITIS. 175 

face, the pupils being too small, add Gelsemium as 
follows : 

Tr. Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half 
or two hours while there is fever. 

Where the stomach is irritated give Aconite instead 
of the Veratrum, and, if indicated, add the Gelsem- 
ium, thus: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a 
half or two hours. 

If the patient is drowsy, the pupils being too 
large, Belladonna should be given instead of the Gel- 
semium, as follows: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half 
or two hours while there is fever. Keep the head 
cool and the feet warm. 

If the pulse is weak or irregular give Digitalis 
and Cactus instead of the Veratrum or Aconite and 
if indicated add the Belladonna, thus: 

Fl. Ext. of Digitalis, 18 drops, 

Fl. Ext. of Cactus Grandiflorus, 36 drops, 



176 THE PRACTICE OF MEDICINE 

Fl. Ext. of Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every two hours. 

Should this fail to improve the heart's action 20 to 
30 drops of the Aromatic Spirits of Ammonia should 
be given, in a sup of water, every two or three hours, 
and if necessary the 1-40 or 1-30 of a grain of the 
Nitrate or Sulphate of Strychnine may also be given 
every three or four hours. 

At the commencement of the attack an Improved 
Compound Cathartic Pill may be given, and if it 
fails to act on the bowels give Oil, Salts, or a Seidlitz 
Powder. Keep the bowels open throughout the attack. 
For this purpose the three last- named remedies may 
be used. 

The kidneys should act freely throughout the 
attack and the following will accomplish this: 

Acetate of Potash, 5 drachms, 

Water, 6 teaspoonfuls. 

Mix and give a teaspoonful every four hours as 
is required. 

The fever is sometimes distinctly periodic; in these 
cases 5 grains of the Sulphate of Quinine should 
be given every two or three hours during the 
remission. 

Should there be coldness of the feet, at any time 
during the attack, bathe them in strong Mustard- 
water as hot as it can be borne, after which wrap 
them well with a blanket and apply heat to them in 



ENDOCARDITIS. 177 

the form of hot irons, bricks, rocks, etc. Where the 
pain is very severe 6 or 8 grains of Dover's Powder 
or from the J to the J of a grain of the Sulphate 
of Morphine may have to be given every three or 
four hours. 

If the patient is delirious Hydrate of Chloral 
should be given in 10-grain doses every hour, in a 
sup of Mint-water, until its effects are obtained, 
when, it should only be administered as demanded. 

Where there is oedema (swelling) of the face or 
extremities, 3 or 4 drops of the Fl. Ext. of Apocy- 
num Cannabinum should be given four times a day. 

Where the disease arises as a secondary affection 
in addition to the foregoing treatment, appropriate 
treatment should be used for the original disease. 

ENDOCARDITIS. 

Endocarditis is an inflammation of the serous 
membrane lining the cavities of the heart and aiding 
in forming its valves; characterized by more or less 
fever, cough, difficult breathing, nausea, vomiting and 
disturbed heart's action. There are two forms of it; 
the acute and the chronic. 

The causes of it are the same as those of peri- 
carditis, however, it might be added that the disease 
is not infrequently associated with chorea. That the 
disease is a microbic affection is gaining ground. 

Symptoms: The symptoms are very much the 
same as those of pericarditis, only, it may be stated, 
that where the inflammation is confined to the endo- 



178 THE PRACTICE OF MEDICINE. 

cardium, pain is rarely felt, though the patient com- 
plains of great oppression, anxiety and faintness. It 
could not be expected, neither is it necessary, that 
the unprofessional attempt to make a differential diag- 
nosis between this and pericarditis as the treatment 
of the two diseases is the same. 

Treatment: Require the patient to assume the 
recumbent position and remain perfectly quiet; and 
in addition to the treatment recommended for peri- 
carditis, appropriate remedies should be administered 
for the original disease. 

ACUTE MYOCARDITIS OR CARDITIS. 

ACUTE INFLAMMATION OF THE HEART. 

This, as its name indicates, is an acute inflamma- 
tion of the muscular tissue of the heart; character- 
ized by pain, fever, weak heart-action, symptoms of 
blood poisoning and great prostration. 

It usually results from pericarditis, endocarditis, 
septicasma, typhoid fever, or an obstruction of the 
coronary arteries. 

Symptoms: These are frequently very obscure, 
however, if, during the course of the diseases men- 
tioned, there are developed pain in the region of the 
heart, difficult breathing, a weak or irregular pulse 
with fever of a low typhoid type and irregular chills 
or rigors, the disease may be suspected. 

Treatment: Perfect rest in bed and the treat- 
ment recommended for pericarditis together with proper 
treatment of the original disease. 



CHRONIC MYOCARDITIS OR CARDITIS. 179 
CHRONIC MYOCARDITIS OR CARDITIS. 

CHRONIC INFLAMMATION OF THE HEART. 

This is a gradually developing inflammation of the 
interstitial connective tissue of the heart resulting in 
hardening of this organ; characterized by pain in the 
heart, shortness of breath on slight exertion, attacks 
of irregular action of the heart and dizziness. 

It may be a result of acute myocarditis, peri- 
carditis, endocarditis, or syphilis, alcoholism and dis- 
eases of the kidneys, but its most common cause is 
a hardening of the coronary arteries, or valvular insuf- 
ficiency, leading to a deficient blood supply to the 
muscles of the heart. It is a disease of the aged, 
however, cases are met with in the young. 

Symptoms: One of the earliest symptoms of the 
disease is extreme shortness of breath with palpita- 
tion of the heart and a weak pulse, upon slight 
exertion. Attacks of pain in the heart or a sensa- 
tion of constriction or pressure over the region of the 
heart are not infrequent, often following slight exertion 
or indigestion. In some cases, presenting no other 
symptom, the pulse-rate is decreased to fifty or even 
thirty per minute. Fainting without warning or after 
sudden exertion, on account of a lessened supply of 
blood to the brain, is common. 

As the disease advances the heart grows weaker, 
the shortness of breath increases and there is cerebral 
weakness showing itself as mania, delusional attacks 
or dementia. If the region of the heart is percussed, 



i8o THE PRACTICE OF MEDICINE. 

dullness is detected and murmurs, the result of val- 
vular lesions may usually be detected by auscultation; 
and a characteristic point is the irregularity of the 
heart's action, one contraction being , forcible and 
another weak or feeble. The disease is one great 
cause of heart-failure. 

Treatment: The disease is incurable, but life 
may be greatly prolonged and made more comfortable 
by adopting the treatment herein given. 

Persons suffering with chronic miyocarditis should 
avoid mental worry and over-exertion and eschew 
alcoholic liquors. 

Where the general health and digestion are 
impaired the following should be given: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Fl. Ext. of Cactus Grand., 2 drachms, 

Fowler's Solution of Arsenic, 1\ drachms, 

Aromatic Elixir, sufficient to make,. 6 ounces. 
Mix and give a teaspoonful before each regular meal. 
Attacks of shortness of breath may usually be 
relieved by 30 to 60-drop doses of the Aromatic 
Spirits of Ammonia repeated every hour or so as the 
urgency of the case demands. From the 1-40 to the 
1-30 of a grain of the Nitrate of Strychnine or 1-100 
of a grain of Nitro- Glycerine, preferably hypoder- 
mically, every three or four hours, is very efficient in 
these cases. 



CHRONIC MYOCARDITIS OR CARDITIS. 181 

Where the heart's action is rapid and weak or 
irregular the following should be given: 

Fl. Ext. of Digitalis, 48 drops, 

Fl. Ext. of Cactus Grand., 2 drachms, 

Fl. Ext. of Nux Vomica, 2 drachms, 

Aromatic Elixir, sufficient to make,. .6 ounces. 
Mix and give a teaspoonful four times a day; 
early of a morning, the middle of the morning, the 
middle of the evening and at night. 

If the urine is scanty give the following: 

Acetate of Potash, 1 ounce, 

Water, sufficient to make, 4 ounces. 

Mix and give a teaspoonful, in a sup of water, 
every four or five hours as is required. 

If the bowels are constipated from 10 to 30 drops 
of the Fl. Ext. of Cascara Sagrada should be given 
before each regular meal, regulating the dose accord- 
ing to its effects on the bowels. 

Pain, when severe, may be relieved by the hypo- 
dermic injection of from the J to a J of a grain of 
the Sulphate of Morphine. 

When fainting occurs place the patient in bed, 
lower the head and administer Strychnine, Aromatic 
Spirits of Ammonia and other stimulants. 

The diet should be nutritious, but all articles that 
disagree with the stomach must be prohibited. Patients 
that are addicted to the use of tea, coffee or tobacco 
may be allowed to use them sparingly. 



1 82 THE PRACTICE OF MEDICINE. 

VALVULAR DISEASES OF THE HEART. 

Diseases of the valves of the heart include all those 
conditions in which there are changes in the structure 
of the valves or of the orifices. The valves may be so 
changed as to be incapable of closing the orifice, and thus 
some of the blood flows back behind the valves, giving 
rise to a condition commonly called regurgitation or in- 
sufficiency. In other cases the orifices may be con- 
tracted, or the valves may be thickened, so as to 
obstuct the flow of blood, a condition that is called 
stenosis. These changes may take place at the open- 
ing between the left auricle and left ventricle, guarded 
by the mitral valve ; at the opening into the aorta, guarded 
by the aortic semi-lunar valve; at the opening between 
the right auricle and right ventricle, guarded by the tri- 
cuspid valve; and at the opening into the pulmonary 
artery, guarded by the right semi-lunar valve. 

Symptoms: When the mitral valve and orifice are 
affected by stenosis, the pulse is small and sometimes 
irregular; there is difficulty in breathing, cough, mucous 
secretions from the bronchial tubes, and sometimes bloody 
sputa or hemorrhage from the air passages; the right 
cavities of the heart are dilated; the veins of the body 
are congested by sluggish circulation, thus giving the 
mucous membranes and skin a bluish tinge; the liver 
is enlarged; abdominal dropsy sets in; the feet and ankles 
become swollen and puffy, indicating general dropsy, 
which soon becomes severe; the urine is scanty and con- 
tains albumen. 



VALVULAR DISEASES OF THE HEART. 183 

In regurgitation, or insufficiency at the mitral orifice, 
an uneasiness is felt in the region of the heart; palpitation 
is almost constant; cough and difficulty in breathing occur; 
the pulse is small, irregular and intermittent; the feet and 
legs become dropsical; the cavity of the abdomen fills 
with fluid ; the urine is scanty and loaded with albumen ; 
and when death occurs the patient is literally drowned 
by the accumulation of fluid in the cavities of the body. 

In stenosis of the aortic valve, the pulse is hard, small 
and slow; there is headache, vertigo, and fainting; some- 
times a sudden relaxation or prostration; difficulty in 
breathing comes on at intervals; bleeding from the lungs 
sometimes occurs; and attacks of neuralgia of the heart 
are developed. 

"In aortic regurgitation the beats of the pulse are sud- 
den and rapid ; headache is present a good deal of the time, 
the pains being of a throbbing character, and associated 
with dizziness and ringing in the ears; and after a time 
these symptoms may be modified, and no more serious 
ones may develop for years." 

"Diseases of the right auriculo-ventricular opening 
are rare, and when they do occur they are associated with 
other conditions, and present the same general symp- 
toms." 

"The opening into the pulmonary artery may be de- 
ranged at birth, or may occur as a result of inflammation 
of the lining membrane of the cavities of the heart. 
Either stenosis or regurgitation, at this uoint, produces 
the same general results." 



1 84 THE PRACTICE OF MEDICINE. 

"As a general rule in all cases of stenosis, when the 
ear is placed over the region of the heart, a sound resem- 
bling that made by a rip-saw is heard; while in regurgita- 
tion, the sound resembles that made by a bellows." 

" While the first symptoms of the various forms of 
valvular diseases of the heart are characteristic and de- 
cided, yet as the diseases progress, the heart accommo- 
dates itself to the new condition, and dilatation and 
hypertrophy of its several parts take place. This is called 
compensatory change and after it occurs the patient may 
be comparatively well for a long period of time. When 
this compensatory action is overcome by over-work, worry 
or any other cause, the symptoms of both stenosis and 
regurgitation are developed; and in the severer cases, 
the general symptoms of dropsy, albumen in the urine, 
difficulty in breathing, etc., come on, no difference 
what may have been the form of the original disease."— 
Gunn. 

Treatment: Patients suffering with valvular disease 
of the heart must avoid all excitement, mental worry and 
over-exertion. The use of alcoholic stimulants must 
be positively prohibited, and the use of tobacco, tea 
and coffee, if used at all, must be very moderate. 

The bowels, when constipated, may usually be regu- 
lated by eating freely of cooked fruits and vegetables. 
Should this fail to regulate them from 10 to 30 drops of 
the Fl. Ext. of Cascara Sagrada should be given three times 
a day, regulating the dose according to its effects on the 
bowels. 



HYPERTROPHY OF THE HEART. 185 

If there is scantiness of urine give 20 grains of the 
Acetate of Potash, in a sup of water, four or five times 
a day as is necessary to obtain the desired results. If 
the pulse is weak or irregular give the following: 

Fl. Ext. of Digitalis, . . .' 48 drops, 

Fl. Ext. of Cactus Grand., 2 drachms, 

Fl. Ext. of Nux Vomica, 2\ drachms, 

Fl. Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make,. .6 ounces. 

Mix and give a teaspoonful four times a day; early of 
a morning, the middle of the morning, the middle of the 
evening and at night. 

Difficult breathing, when present, may be relieved 
by Aromatic Spirits of Ammonia in from 30 to 60-drop 
doses every hour or so as the urgency of the case 
demands. 

The Sulphate or Nitrate of Strychnine in doses of 
from 1-40 to 1-30 of a grain, or the Sulphate of Sparteine 
in doses of \ of a grain, every four hours, is very efficient 
in these cases. 

Where there are symptoms of dropsy, such as swelling 
or puffiness of the feet and ankles, or other parts of the 
body, give 3 drops of the Fl. Ext. of Apocynum Canna- 
bium four or five times a day. For the further treatment 
of dropsy the reader is referred to that disease (?). 

HYPERTROPHY OF THE HEART. 

ENLARGEMENT OF THE HEART. 

Hypertrophy of the heart is an increase in the size of 
this organ, resulting from an over-growth of its muscular 



186 . THE PRACTICE OF MEDICINE. 

tissue; characterized by forcible action of the heart; 
unusual fullness of the arteries; less blood than natural 
in the veins, pulsating carotids and headache. 

In simple hypertrophy there is an increase in the 
thickness of the walls of the heart. In what is known 
as eccentric hypertrophy, in addition to the thickening 
of the walls, there is also a dilatation of its cavities. There 
is another form of hypertrophy, known as concentric, 
but it is exceedingly rare. It is an increase in the thick- 
ness of the walls of the heart and a decrease in the size 
of its cavities. 

The principal causes of it are valvular diseases of the 
heart; diseases of the arteries; Bright 's disease of the 
kidneys; emphysema; continued over-exertion and the 
excessive use of alcoholic liquors, tea, coffee and to- 
bacco. 

Symptoms: There is shortness of breath, especially 
on the slightest exertion; palpitation of the heart, some- 
times exceedingly severe; headache; ringing in the ears, 
often dizziness; congestion of the face and eyes; bleeding 
from the nose; dry cough; and the patient restless during 
the night with more or less jerking of the limbs. The 
pulse is full and strong and if there is no dilatation of the 
cavities of the heart the entire body shakes at each pulsa- 
tion. In most cases, sooner or later, there is a dropsical 
condition, which is known by a swelling or puffiness of 
the feet and legs. Finally, on account of the great diffi- 
culty in breathing, the patient becomes unable to assume 
the recumbent position and death soon closes the scene. 



DILATATION OF THE HEART. 187 

Treatment: In order to control the heart's action 
give 2 or 3 drops of the Tr. of Veratrum Viride, or the same 
amount of Tr. of Aconite Root, every four hours while 
the pulse is too full and too strong. Keep the bowels 
slightly open and the kidneys acting freely. The ad- 
ministration of from 10 to 30 drops of the Fl. Ext. of Cas- 
cara Sagrada, before each regular meal, will keep the 
bowels in good condition; while 20 grains of the Acetate 
of Potash, given in water, every four hours on alternate 
days, will be all that is required for the kidneys. 

All active physical exertion or mental worry must be 
avoided; and the use of alcoholic spirits, tobacco, tea and 
coffee, when used, must be abandoned; the diet should 
be light, and, if possible, the recumbent position should 
be assumed several hours during each day. See Dropsy. 

DILATATION OF THE HEART. 

This is an increase in the size of one or more cavities 
of the heart; characterized by feeble pulse, blueness of the 
lips, fullness of the veins, a dropsical condition of the 
feet and legs, and sometimes the abdomen and finally 
exhaustion. It may occur and the walls of the heart 
remain normal, or they may be thinned or hypertrophied. 

The most common causes of it are valvular disease, 
over-exertion, especially in those who possess feeble 
resisting powers; emphysema; chronic bronchitis, gout, 
Bright 's disease of the kidneys; the excessive use of alco- 
holic liquors and syphilis. 

Symptoms: A characteristic symptom of dilatation 
of the heart is a weak, rapid irregular pulse with head- 



1 88 THE PRACTICE OF MEDICINE. 

ache, aggravated by the upright position. The veins 
are full and the arteries rather empty, producing more 
or less blueness of the surface. Shortness of breath and 
attacks of dizziness with fainting are common. There 
is frequently indigestion, constipated bowels, scanty, al- 
buminous urine, jaundice, slight hacking cough and more 
or less dullness of the mind. Dropsy with exhaustion 
finally supervenes ending in dissolution. 

Treatment: Where the pulse is weak or irregular, 
give the following: 

Fl. Ext. of Digitalis, 48 drops, 

Fl. Ext. of Cactus Grandiflorus, ... 2 drachms, 
Aromatic Elixir, sufficient to make, . . 6 ounces. 
Mix and give a teaspoonful four times a day; early 
of a morning, the middle of the morning, the middle of 
the evening and at night. 

If the patient is debilitated and the digestion feeble, 
give the following instead of the foregoing: 

Fl. Ext. of Digitalis, .48 drops, 

FL Ext. of Cactus Grand., 2 drachms, 

Fl. Ext. of Nux Vomica, 2 \ drachms, 

Fl. Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make, . . 6 ounces. 
Mix and give a teaspoonful four times a day. If there 
is swelling or puffiness of the feet or ankles add 3 or 4 
drops of the Fl. Ext. of Apocynum Cannabinum to each 
dose of the foregoing. 

For the attacks of dizziness and fainting put the pa- 
tient to bed, lower the head and give from 30 to 60 drops 



FATTY DEGENERATION- OF THE HEART. 189 

of the Aromatic Spirits of Ammonia every hour or so as 
the urgency of the case demands. Where the heart's 
action is very weak it may be necessary to give the Nitrate 
of Strychnine or the Sulphate of Sparteine every three or 
four hours. The dose of the first named is from the 1-40 
to the 1-30 of a grain and the latter -J- of a grain. Strych- 
nine is made from Nux Vomica, therefore, both remedies 
should not be administered to a patient at the same time 
as there would be danger of obtaining the poisonous 
effects of them. 

The bowels must be kept well regulated, and for this 
purpose from 10 to 30 drops of the Fl. Ext. of Cascara 
Sagrada should be given three times a day as is necessary. 

If there is scantiness of urine give 20 grains of the 
Acetate of Potash four or five times a day. 

The patient should take daily exercise in the open 
air, but fatigue or excitement must be avoided. The 
free use of good red wine is beneficial. 

The diet should be of the most nutritious character. 

FATTY DEGENERATION OF THE HEART. 

This is a change of the muscular tissue of the heart 
into fat; characterized by feeble action of the heart, full- 
ness of the veins, especially those of the neck, difficult 
breathing and finally dropsy. 

It is caused by diseases of the coronary arteries; defi- 
cient nutrition in the elderly; prolonged anaemia; the 
excessive use of alcoholic spirits; gout; phosphorus poi- 
soning; scrofula; tuberculosis or cancer. 



190 THE PRACTICE OF MEDICINE. 

Symptoms: The disease may exist in an advanced 
form without producing any observable symptoms, how- 
ever, there is usually a small, weak, irregular pulse, which 
in some cases, sinks to 30 or 40 beats per minute. The 
respiration is slow and sometimes irregular (Cheyne- 
Stokes breathing), appearing as if the patient had forgot- 
ten to breathe; faintness upon the slightest exertion, and 
sometimes actual fainting occurs. Distress and difficult 
breathing, on taking active exercise, are felt long before 
any suspicion of heart-trouble is entertained. The veins 
of the neck are habitually distended while the face assumes 
a bluish tinge; indigestion and constipation of the bowels 
are common and there is scanty, albuminous urine. 
Finally the feet and legs become dropsical, the liver 
enlarges, abdominal dropsy comes on and the patient 
shortly expires. 

Treatment: As it is impossible to restore the de- 
generated muscular tissue, the disease is incurable. 

Where the heart's action is feeble and rapid and the 
patient anaemic the following should be given: 

Fl. Ext. of Digitalis, .48 drops, 

Fl. Ext. of Cactus Grand., 2 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Fl. Ext. of Nux Vomica, 2 J drachms, 

Aromatic Elixir, sufficient to make, . . 6 ounces. 
Mix and give a teaspoonful four times a day; early of 
a morning, the middle of the morning, the middle of the 
evening and at night. If the pulse is slow the Digitalis 



FATTY DEGENERATION OF THE HEART. 191 

should be omitted from the foregoing formula, as it is 
contra-indicated in such cases. 

The Nitrate of Strychnine and also the Sulphate of 
Sparteine are valuable heart-stimulants and may be used 
in these cases. The dose of the first named is from 1-40 
to 1-30 of a grain, and of the latter, ^ of a grain, every 
three or four hours. The Strychnine and Nux Vomica 
should not be given at the same time. 

Should fainting occur, put the patient to bed, lower 
his head and give 30 drops of the Aromatic Spirits of 
Ammonia every hour or so as is required. The Strych- 
nine and Sparteine previously recommended may also 
be used in these cases. 

If the bowels are constipated, administer from 10 to 
30 drops of the Fl. Ext. of Cascara Sagrada three times 
a day as is required to regulate them. 

If the urine is scanty, give 20 grains of the Acetate of 
Potash, or 30 drops of the Fl. Ext. of Buchu, four or five 
times a day as is required. 

When the symptoms of dropsy make their appearance, 
give 3 or 4 drops of the FL Ext. of Apocynum Can- 
nabinum four times a day. Should this fail to afford 
relief, the treatment recommended for dropsy should be 
given. 

The patient must be impressed with the importance 
of avoiding mental worry and all active physical exertion, 
however, moderate exercise cautiously taken in the open 
air is beneficial. 



192 THE PRACTICE OF MEDICINE. 

The diet should consist of an abundant supply of 
animal food and other articles of the most nutritious 
character. 

PALPITATION OF THE HEART. 

IRRITABLE HEART. 

Palpitation is a functional disturbance of the heart, 
occurring without any structural disease of this organ; 
characterized by paroxysms of rapid, irregular, tumul- 
tuous beating of the heart accompanied by a sensation 
of choking and fullness in the throat. 

The usual causes of it are indigestion, mental excite- 
ment or worry, over-exertion, diseases of the nervous 
system, the immoderate use of alcoholic spirits, tobacco, 
tea, and coffee, inordinate venery. 

Symptoms: The paroxysms of palpitation usually 
commence suddenly with rapid, irregular and tumultuous 
beating of the heart accompanied by anxiety, a fear of 
impending danger, a sense of choking and fullness in 
the throat and inability to assume the recumbent position. 
The pulse is either full and strong or feeble and irregular; 
the face flushed or pale. These attacks come on sud- 
denly at any time. Sometimes the shutting of a door, 
or any loud noise, is sufficient to produce them; and they 
may continue only a few minutes or several hours, the 
patients often voiding a large quantity of pale urine after 
the paroxysms have subsided, when, there is a tendency 
to sleep. 

Treatment: If possible ascertain and remove the 
cause. 



ANGINA PECTORIS. 193 

Where the pulse is too full and too strong give 2 or 
3 drops of the Tr. of Veratrum four or five times a day. 
If the pulse is weak, give the following: 

Fl. Ext. of Digitalis, 48 drops, 

Fl. Ext. of Cactus Grandiflorus, ... 2 drachms, 
Aromatic Elixir, sufficient to make, . . 6 ounces. 

Mix and give a teaspoonful four times a day. 
If the patient is anaemic, the pulse weak and the di- 
gestion impaired, give the following: 

Fl. Ext. of Digitalis, 48 drops, 

Fl. Ext. of Cactus Grandiflorus, ... 2 drachms, 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Canadensis, . . . 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make, . . 6 ounces. 

Mix and give a teaspoonful before each regular meal. 
If the bowels are constipated give 10 to 30 drops of the 
Fl. Ext. of Cascara Sagrada three times a day. 

ANGINA PECTORIS. 

NEURALGIA OF THE HEART. 

Angina pectoris is a disease; characterized by parox- 
ysms of agonizing pain in the region of the heart, extend- 
ing to the left shoulder, arm, and neck and attended by 
a sense of impending death. 

The causes of it are diseases of the aorta, coronary 
arteries and valves of the heart; the inordinate use of to- 
bacco; syphilis, and often associated with hysteria. The 
disease is often hereditary and occurs most frequently 



i 9 4 THE PRACTICE OF MEDICINE. 

in men after the fortieth year. Trousseau says, that it is 
a form of masked epilepsy and may alternate with true 
epileptic attacks. 

Symptoms: An attack usually begins suddenly after 
over-exertion, excitement, or anger with a paroxysm of 
anxiety, oppression and agonizing pain in the region of 
the heart, extending to the left shoulder, arm and neck. 
Coldness and numbness of the fingers, or over the region 
of the heart, may be present. One characteristic symptom 
of the disease is the awful fear of impending death, which 
is no less agonizing than the pain. The face is frequently 
pale and may assume a leaden hue and is usually bathed 
in cold perspiration. The respirations are shallow or 
sometimes temporarily arrested and the patient's anxiety 
is extreme. The pulse may be regular and even fuller 
than natural. The duration of a paroxysm is from a few 
seconds to several minutes or hours. After the paroxysm 
subsides there may be eructations of gas, vomiting, or the 
discharge of a large amount of pale urine. Careful ex- 
amination of the heart, after the paroxysm is at an end 
may fail to reveal any pathological symptoms; though, 
there is weakness, it soon disappears. The attacks recur 
at intervals varying from a few days to many years. Pa- 
tients afflicted with the disease may die during the first 
or any subsequent paroxysm or may die suddenly during 
the interval between them. 

Treatment: The inhalation of the Nitrite of Amyl 
in doses of from 3 to 5 drops from a handkerchief or nap- 
kin usually relieves the paroxysm very promptly. Should 



ANGINA PECTORIS. 195 

this fail to control the pain, administer a hypodermic 
injection of J of a grain of the Sulphate of Morphine. 
Chloroform also acts promptly in these cases. A half- 
drachm of it may be poured upon a sponge or some cotton 
at the bottom of a wide-mouthed bottle and inhaled at 
pleasure. Nitro- Glycerine given hypodermically in doses 
of from 1-150 to 1-100 of a grain every three to five hours, 
is also efficient. Where it produces headache make the 
dose slightly smaller. 

In order to prevent a recurrence of the paroxysms 
1-200 of a grain of the Nitro- Glycerine should be 
given three or four times a day for a long time. The 
Sulphate of Sparteine in doses of -g- of a grain may also 
be used in the same manner for the same purpose. 
The Nitro- Glycerine and also the Sparteine may be ob- 
tained in tablet-form, each tablet containing the required 
dose. 

The Iodide of Potash may be given in doses of 20 
grains after each regular meal for several years, omitting 
it for ten days each month. It has produced good results 
in these cases when used in this manner. English Haw- 
thorn (Crategus Oxycantha) in the form of the Fl. Ext. 
is highly recommended in these cases. 

Persons who are subject to attacks of angina pectoris 
should carry Perles of Nitrite of Amyl with them and 
upon the first symptom of a paroxysm use them. 

The patient should lead a quiet life, avoiding all 
excitement and sudden physical exertion. 



196 THE PRACTICE OF MEDICINE. 

ANEURISM. 

Aneurism is a circumscribed dilatation of an artery 
resulting from a diseased condition of its wall, weakening 
its resistance to the blood pressure. Usually one or more 
coats of the artery are ruptured, from some cause, before 
the dilatation of the remaining coat or coats take place. 
The thoracic portion of the aorta is involved in about 
75 per cent, of the cases; and the abdominal aorta and its 
branches in 25 per cent. Where the blood passes between 
the coats of the artery, forming a tumor, it is known as 
dissecting aneurism; other forms, are known as circum- 
scribed aneurism. Men are more subject to it than 
women; and it occurs most frequently between the thir- 
tieth and fiftieth years. 

Its most common causes are arterio-sclerosis, syphilis, 
sudden great strain and wounds. 

Symptoms: When occurring at the arch of the aorta 
the onset is usually gradual with evidences of a thickening 
and hardening of the walls of the arteries and an impair- 
ment of the general health. There is more or less pain, 
difficult breathing, and sometimes difficulty in swallowing. 
There is a slight cough; more or less alteration in the 
voice; dilated, contracted or irregular pupils; a gradual 
loss of flesh and the patient has a care-worn expression. 
Sooner or later a pulsating tumor may be detected. 

When the thoracic aorta is the seat of the tumor 
a deep-seated pain, either constant or paroxysmal is 
present. A diagnosis, when the lesion is in the thorax, 
is rarely ever made during life. 



ANEURISM. 197 

When occurring in the abdominal aorta there is con- 
stant pain in the abdomen, usually circumscribed, with 
the presence of a pulsating tumor and gradual loss of 
health. Where the tumor interferes with the venous 
circulation dropsy ensues. 

Treatment: Absolute rest of the patient's mind 
and body, in bed day and night for at least three months 
and a dry and very much restricted diet, consisting of 
bread, butter, meat and a very ' small amount of milk. 
At the same time administer 20 grains of the Iodide of 
Potash three times a day. This treatment when persist- 
ently followed, is believed to promote clotting in the aneu- 
rismal sack thereby effecting a cure. 

Galvano-puncture will sometimes produce the same 
result. It is performed by inserting two needles into 
the sack, connecting them with the poles of a galvanic 
battery and passing a weak current of electricity through 
the tumor. 

The Moore-Corradi method consists of the introduc- 
tion, through a hollow needle of several feet of fine silver 
wire, coiling it within the sack and passing a strong cur- 
rent of galvanic electricity through it for one or two hours, 
but this method is not without serious danger. 

Keep the entire system in as near a normal condition 
as possible, meeting the various symptoms, as they arise, 
with appropriate treatment. 

Avoid all excesses of every description, and if the 
patient uses alcoholic liquors, tea, coffee, or tobacco, 
it must be very sparingly. 



198 THE PRACTICE OF MEDICINE. 

PHLEBITIS. 

INFLAMMATION OF A VEIN. 

Phlebitis is an inflammation of a vein; characterized 
by a chill, fever, pain along the course of the vein and 
more or less swelling. 

Its most common causes are wounds, local inflamma- 
tion, disease of the bones, skin affections, especially those 
that give rise to the formation of pus; and it is not infre- 
quently a result of puerperal fever. Both sexes are subject 
to it. 

Symptoms: An attack usually commences with a 
well-marked chill or rigor, followed by fever, usually of 
a remittent type and severe pain along the course of the 
vein, which, when superficial, becomes hard and knotted, 
resembling a cord under the skin. The skin over the 
vein involved is red and swollen. The tongue is coated 
with a whitish fur; the appetite impaired; the bowels con- 
stipated and the urine scanty and high-colored. Where 
appropriate treatment is commenced early in the attack 
resolution is usually established within a few days and 
recovery follows, especially in favorable cases. Other- 
wise, pus is formed resulting in an abscess and, in many 
cases, septicaemia with a low typhoid-like type of fever. 

Treatment : Control the fever in this as in any other 
disease with sedatives administered according to indica- 
tions, and where the fever is high, the pulse full and 
strong and the skin dry give from 3 to 5 grains of 
Acetanilide every three or four hours. 



PHLEBITIS. 199 

A sufficient amount of Salts should be given at the 
beginning of the attack to act freely on the bowels and 
afterwards given daily in smaller doses as is needed to 
keep the bowels moderately open. 

If the urine is scanty give 20 grains of the Acetate of 
Potash every four hours until the desired effect is obtained, 
when, it should be administered, as it is required to keep 
the kidneys acting. 

Where the tongue is broad, pallid, and uniformly coated 
with a filthy whitish material, give 20 grains of the Sulphite 
of Soda every four or five hours until it becomes clean 
or changes its color. Instead of being broad and pallid, 
the tongue is frequently red and dry. In this condition 
3 drops of Hydrochloric Acid, well diluted with water, 
should be given every three or four hours. Where the 
Acid is given Buchu should be used instead of the Potash 
previously mentioned. 

Where the tongue is dark- red, or purplish in addition 
to the Hydrochloric Acid, the following should be given: 

Fl. Ext. of Baptisia, 36 drops, 

FL Ext. of Echinacea, 6 drachms, 

Water, 12 teaspoonfuls. 

Mix and give a teaspoonful every three or four hours. 

As a local application poultices, as hot as can be borne 
by the patient should be applied and changed frequently. 

Should an abscess develop, it should be emptied as 
soon as pus is formed, and the cavity thoroughly cleansed 
with Peroxide of Hydrogen and then dressed with dry 



200 THE PRACTICE OF MEDICINE. 

Iodoform. These dressings should be repeated sufficiently 
often to insure cleanliness. See Septicaemia. 

VARICOSE VEINS. 

ENLARGED VEINS. 

This is an enlargement or dilatation of the veins, usu- 
ally of the lower extremities, as the veins of these parts 
are forced to sustain a column of blood, which exerts con- 
siderable dilating force, especially during violent exercise, 
as in wrestling or carrying heavy loads. This force is 
sometimes so great that the vein- walls are ruptured and 
hemorrhage occurs into the surrounding tissue. Where 
the enlargement or dilatation has progressed to any con- 
siderable extent the superficial veins may be clearly seen 
through the skin, appearing twisted, knotted and filled 
with blood. The legs frequently become swollen or puffy 
on account of the obstruction of the veins. When the 
patient is on his feet during the day the swelling is 
increased; and after rest in a horizontal position the 
swelling subsides to a great extent. The condition is not 
infrequently a result of pregnancy. 

Treatment: It is claimed that the Fl. Ext. of Hama- 
melis Virginica (Witch Hazel) administered three times 
a day in from 5 to 10-drop doses, improves the condition 
of the veins and relieves their fullness, but we think this 
very doubtful, however, it may be given a trial. 

Rest and mechanical pressure in the form of a flannel 
bandage or what is better an elastic stocking, are the most 
efficient means in the treatment of varicose veins. The 
bandage when used, should be about four inches wide 



SEPTICEMIA. 201 

and must be applied evenly from the toes up the limb 
using a little more pressure on the foot and ankle than 
on the other parts. The stocking most commonly required 
is a number four or five, but those who have large limbs 
require a number six or seven. 

The health of feeble patients must be improved by 
a generous diet and the administration of the following: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make, . . 6 ounces. 
Mix and give a teaspoonful before each regular meal. 
Operative measures are recommended, but they are 
not altogether free from danger, besides they frequently 
fail to afford relief. 

Where the disease is a result of pregnancy the bowels 
must be kept open and the patient required to remain in 
the recumbent position the greater part of her time. 

SEPTICEMIA. 

BLOOD-POISONING. - 

Septicaemia, or blood-poisoning, as its name indicates, 
is a disease in which there is a septic material in the fluids 
of the body; characterized by chills or rigors, a typhoid-like 
type of fever, quick, feeble pulse, prostration, delirium, and 
in what is known as pyaemia the formation of abscesses. 
In the last-named form of the disease abscesses may form 
in various parts of the body, both internally and exter- 
nally; internally, especially in the lungs, and externally 
in any of the soft tissues. 



202 THE PRACTICE OF MEDICINE. 

The cause of it is the absorption of pus cocci or their 
ptomaines, which cannot occur unless there is a wound 
or an abrasion of the skin or mucous membranes. It 
is most liable to occur in wounds not treated antiseptic- 
ally, or in those from their nature or location that cannot 
be thoroughly disinfected and protected, and following 
confinement or abortion. It may also follow pneumonia, 
pleurisy, erysipelas, typhoid fever, carbuncle, tubercu- 
losis, appendicitis, phlebetis, etc. 

Symptoms: In septicaemia or pyaemia the period 
of invasion of the cocci or their ptomaines is generally 
very short, usually not more than twenty-four hours. 
During this time the patient is usually languid; and when 
from an injury or an operation, complains of more or 
less pain in the part. Sooner or later a chill or rigor 
occurs, lasting from a few minutes to one or two hours, 
when reaction occurs; the temperature reaching 102 to 
106 Fahr. ; and is followed by profuse perspiration. The 
chills or rigors may occur several times a day, or but 
once a day; or there may be none after the first one. The 
pulse is usually small and frequent, becoming thready; 
the tongue rs red, soon becoming brown and dry; the teeth 
and lips are covered with sordes; the stomach is irritable, 
and nausea with vomiting occurs from slight causes; 
diarrhoea sometimes occurs, the discharges being dark 
and very offensive; the urine is high-colored, scanty and 
fee ted; the extremities cool; the trunk hot; there is de- 
lirium; there are involuntary discharges of the fceces 
and urine; a tenderness of the entire body, and some- 



SEPTICEMIA. 203 

times severe pains in the internal organs and joints. 
These symptoms increase day by day, bearing a close 
resemblance to a severe case of typhoid fever. In many 
cases there is an inflammation of the lungs or some other 
internal organ, the joints or soft parts. These inflamma- 
tions run a rapid course and always terminate in suppur- 
ation, sometimes several parts are affected at the same 
time or many small abscesses form in various parts of the 
body. The inflammation and abscesses occur more es- 
pecially with the form of the disease known as pyaemia, 
which means, literally, pus in the blood. 

Treatment: Septicaemia or blood-poisoning, result- 
ing from a wound, can usually be prevented by thor- 
oughly washing all wounds with a 1 to 2000 solution of 
Bichloride of Mercury, then,, dusting the wound with 
Iodoform, after which bringing the parts together and 
covering the wound with Bichloride-Gauze and this with 
absorbent cotton, and, then, carefully applying a roller 
bandage. Should pus appear in the wound it must be 
removed with Peroxide of Hydrogen, which effervesces 
with pus, and, then, the wound dressed as previously 
directed. 

When abscesses form they should be thoroughly 
emptied and their cavities cleansed with Peroxide of Hy- 
drogen and then dressed as previously recommended 
for wounds. 

Endeavor to keep the bowels and kidneys in a normal 
condition throughout the attack. 



2o 4 THE PRACTICE OF MEDICINE. 

Control the fever with sedatives, administered ac- 
cording to indications as in any other disease. If the 
pulse is quick, full and strong give Aconite or Veratrum 
and if there is flushed face, bright eyes and contracted 
pupils add Gelsemium; and, in all cases of blood-poison- 
ing add Echinacea, thus: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Fl. Ext. of Echinacea, ; 6 drachms, 

Water, 12 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half 
or two hours. If the fever is high, in addition to the 
foregoing, give from" 3 to 5 grains of Acetanilide every 
three or four hours. 

When the pulse is weak or irregular give Digitalis 
and Cactus, instead of the Aconite or Veratrum, adding 
the Echinacea as follows: 

Fl. Ext. of Digitalis, 18 drops, 

Fl. Ext. of Cactus Grand., 36 drops, 

Fl. Ext. of Echinacea, 6 drachms, 

Water, 12 teaspoonfuls. 

Mix and give a teaspoonful every two hours. Where 
the patient is very weak, from the 1-60 to the 1-40 of a 
grain of the Sulphate of Strychnine should also be given 
every four hours. Whiskey and Aromatic Spirits of 
Ammonia are also valuable stimulants in these cases and 
their use should not be neglected. The former is a very 
valuable food, especially when given in the form of Egg- 
Nog or Milk-Punch. 



DROPSY 205 

When the fever is distinctly periodic Quinine should 
be given. It may be used as in remittent fever. 

In cases where the formation of pus is profuse J of 
a grain of the Sulphide of Calcium should be given every 
four or six hours. 

When the disease follows confinement or abortion, 
in addition to the foregoing treatment, the womb and 
vagina should be thoroughly washed out with douches of 
a 1 to 4000 solution of Bichloride of Mercury, two or three 
times a day, and the following added to each dose of the 
Aconite, Veratrum or Digitalis- mixt .ires: 

Fl. Ext. of Cimicifuga, 3 drops, 

Fl. Ext. of Phytolacca Dec, 1 drop. 

These may be added when the preparation, just men- 
tioned, is prepared. 

Any remedy, if indicated, used in typhoid fever may 
also be used in septicaemia. 

Profuse perspiration, when present, may be treated 
similarly to night-sweats. 

Let the patient's diet be of the most nutritious char- 
acter, but it should consist of articles that are easily 
digested. 

DROPSY. 

Dropsy is an unnatural accumulation of a watery 
fluid in some cavity, or the areola texture, of the body. 
It is really not a disease, as is popularly believed, but only 
a symptom and as it may be a result of various diseases, 
a separate notice of it is demanded. 



206 THE PRACTICE OF MEDICINE. 

The cardinal elements in the causation of dropsy are 
obstructed venous circulation, arrested excretion and 
absorption and an excess of water in the blood. Either 
one of these causes may induce it. Dropsy follows dis- 
eases of the heart or liver on account of the obstruction 
of the venous circulation; diseases of the kidneys, or the 
action of cold on the skin on account of excretion's being 
checked; and wasting diseases on account of the watery 
state of the blood. 

A collection of serum, or watery fluid, in the cavity 
of the skull is called hydrocephalus; in the sack (peri- 
cardium) that envelops the heart, hydropericardium ; 
in the chest, between the lungs and the lining mem- 
brane of the chest-wall, hydrothorax; in the abdomen, 
ascites; in the scrotum, hydrocele; and in the 
areola texture, anasarca, or general dropsy. 

HYDROCEPHALUS. 

DROPSY OF THE BRAIN. 

This, as previously stated, is an accumulation of a 
watery fluid in the cavities of the brain or between the 
brain and the skull; characterized by enlargement of the 
head and more or less disturbance of the nervous system. 

It is almost exclusively a disease of infants or very 
young children, and especially those whose parents are 
scrofulous, tuberculous, or syphilitic. It is usually the 
result of an inflammatory condition of one of the cover- 
ing membranes of the brain. The eruptive fevers, whoop- 
ing-cough, diseases of the bowels, etc., may be its exciting 
cause. 



HYDROCEPHALUS. 207 

Symptoms: The symptoms at the beginning of an 
attack are variable, however, there are usually more or 
less impairment of digestion, constipation or irregularity 
of the bowels, feebleness of the circulation, coldness of 
the extremities, pallidity or puffiness of the face, and, if 
the child can talk, it will probably complain of its head, 
or, if it cannot talk, it may roll its head from side to side, 
frequently throwing its hands to it. As the disease ad- 
vances the child becomes stupid, the pupils dilated, the 
eyes are involuntary rolled about, it sleeps with the eyes 
partly open, the pulse grows weaker day by day and the 
symptoms of pain, previously mentioned, are now absent. 
The head increases in size until, in some cases, it becomes 
enormously large. The sutures of the skull separate, 
sooner or later convulsions occur and the little sufferer 
finally expires. This usually occurs within the first year, 
however, cases of fifteen or twenty years' duration are 
recorded. 

Treatment: Various plans of treatment have been 
tried but with little or no benefit. The remedies which 
we prefer in these cases are Apocynum Cannabinum and 
the Iodide of Potash. The dose of the first named for a 
child one year old and under is from a 1-12 to 1-5 of a 
drop. It may be prepared for administration as follows: 
Fl. Ext. of Apocynum Cannabinum,. .2 drops, 
Water, 10 drops. 

Mix and give one drop of the mixture four or five times 
a day. The dose of the Potash for a child one year old 
and under is from J to 1 grain three times a day. 



208 THE PRACTICE OF MEDICINE. 

See that the patient has a free action from the bowels 
each day and if there is diarrhoea it must be relieved by 
appropriate treatment. 

Where there is scantiness of urine give Acetate of 
Potash every three or four hours. The dose of it and 
the Iodide is the same. 

Should convulsions occur Chloral Hydrate may be 
given every half -hour until they are controlled. The 
dose of it is one grain for each year of age up to twenty 
years. 

There is good authority for evacuating the fluid with 
an aspirator, using the finest needle, but there can be 
little, if any, good derived from this operation, however, 
it might be tried as a last resort. 

When patients have fever it should be controlled with 
sedatives administered according to indications in this 
as in any other disease. 

HYDROPERICARDIUM. 

DROPSY OF THE HEART. 

This is an accumulation of a watery fluid in the peri- 
cardium; characterized by dim cult breathing and swal- 
lowing, distress in the region of the heart with more or 
less disturbance of its action. 

It may be a part of a general dropsy, or it may result 
from Bright 's disease of the kidneys, pressure of an aneu- 
rism, etc. 

Symptoms: There is usually more or less palpitation 
of the heart; irregular pulse, shortness of breath, which 
is sometimes so severe that the patient is compelled to 



HYDROPERICARDIUM. 209 

remain in an erect posture in order to breathe at all, and, 
if the pericardium is greatly distended, there is apt to be 
difficulty in swallowing; and if the region over the heart 
is percussed unnatural dullness is detected. 

Treatment: This will depend to a great extent on 
its cause, which should be determined and removed if 
possible. Great benefit is usually derived from the fol- 
lowing : 

Fl. Ext. of Digitalis, | drachm, 

Fl. Ext. of Cactus Grand., 1 drachm, 

Fl. Ext. of Apocynum Can., 1 drachm, 

Water, sufficient to make, 4 ounces. 

Mix and give a teaspoonful every four hours. 

Acetate of Potash or the Fl. Ext. of Hair-Cap Moss, 
should be given every four or five hours for the purpose 
of increasing the flow of urine. The dose of the first is 
20 grains and of the latter 20 to 30 drops. 

Where the patient's strength is good from 1-12 to 1-8 
of a grain of Elaterium given every four hours until free, 
watery discharges are obtained from the bowels, will 
usually afford marked relief. Instead of the Elaterium a 
tablespoonful of common Salts and a teaspoonful of Cream 
of Tartar may be dissolved in a half a glass of water and 
given every four hours until copious, watery discharges 
are obtained from the bowels. These remedies may be 
repeated in this manner every day or two as the patient's 
strength will bear them. 

Should the patient be greatly debilitated, in addition 
to the foregoing treatment, administer the following: 



210 THE PRACTICE OF MEDICINE. 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Gentian, 3 ounces, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Aromatic Elixir, sufficient to make, . . 6 ounces. 
Mix and give a teaspoonful three times a day before 
meals. 

As a last resort the fluid may be withdrawn with an 
aspirator. 

HYDROTHORAX. 

DROPSY OF THE CHEST. 

This is an accumulation of a watery fluid in the pleural 
cavity; characterized by irregular pulse, difficulty in breath- 
ing, dullness on percussion, a dry, hacking cough, inability 
to lie on the affected side or if both sides are involved 
an inability to assume the recumbent position. 

It may be produced by the various causes that produce 
other forms of dropsy such as diseases of the kidneys, 
heart, etc., or, it may be the result of a general dropsy. 

Symptoms: In the early stage of the disease there 
is oppression, difficulty in breathing, which is increased 
by unaccustomed exercise or by assuming the recumbent 
position, especially where the amount of fluid is great or 
when both sides are involved. If the accumulation of 
fluid is confined to one side the patient is unable to lie 
on the other side. 

In an advanced stage of the disease there is a short, 
dry, hacking cough; frequent shivering; irregularity of 
the pulse; a sense of oppression and heaviness at the pit 
of the stomach; palpitation of the heart; disturbed sleep 



ASCITES. 211 

and an inability to lie down, the patient being forced to 
maintain a sitting posture. Finally the face, lips and hands 
present a livid, or mottled appearance; there is swelling 
or puffiness of the feet and legs, great thirst, numb- 
ness of one or both arms, swelling of the lower eyelids, 
the urine being scanty and high-colored. There is, at 
this stage, marked dullness on percussion, enlargement 
of the side or sides; bulging of the intercostal spaces; and, 
finally, a clammy sweat occurs upon the face and upper 
part of the body, followed by drowsiness or delirium, 
which is caused by insufficient oxygenation of the blood 
and want of sleep. Death may take place suddenly, or 
it may be preceded for a few days by slight hemorrhages 
from the lungs. 

Treatment : The same as that recommended for 
dropsy of the heart. 

ASCITES. 

DROPSY OF THE ABDOMEN. 

This, as its name indicates, is a collection of a watery 
fluid in the peritoneal cavity; characterized by enlarge- 
ment of the abdomen, difficulty in breathing, disturbed 
action of the heart, etc. 

Its most common causes are diseases of the liver and 
kidneys. 

Symptoms: In addition to the symptoms of the dis- 
ease that produces it, the first thing that attracts attention 
is the swelling of the abdomen. In the sitting posture, 
the fullness is greatest in the lower part of the bowels, 
but when the patient lies down the fluid gravitates to 



212 THE PRACTICE OF MEDICINE. 

the most dependent part and its position is immediately 
changed by a change of the patient's position. 

As the amount of fluid increases in the peritoneal 
cavity, the abdomen becomes greater in circumference 
until it is frequently two or three times its natural size. 
By placing a hand on each side of the abdomen and making 
pressure alternately, first on one side and then on the 
other, the motion of the fluid can be distinctly felt. 

As the amount of fluid increases the diaphragm is 
pushed upwards, thus making the thoracic cavity smaller 
and compressing the heart and ' lungs, rendering 
the heart's action irregular and the breathing difficult. 
The urine becomes scanty, the bowels constipated, the feet 
and legs swollen, and, in a majority of cases, death soon 
closes the scene. 

Treatment: Detect the cause and if possible, re- 
move it. In other respects the treatment is the same as 
that of dropsy of the heart. 

In many cases life may be prolonged by " tapping. " 
This is accomplished by means of a trocar and canula 
or an aspirator. 

HYDROCELE. 

DROPSY OE THE SCROTUM. 

Hydrocele is an accumulation of a watery fluid in the 
scrotum; characterized by an increase in its size and more 
or less translucency of the part. 

Symptoms: The first symptom that attracts atten- 
tion is a swollen condition of the lower part of the scrotum 
and it will be observed that this swelling is gradually 



ANASARCA. 213 

extending upwards; the tumor finally becoming pear- 
shaped, when it feels similar to a bladder distended with 
water. The scrotum is sometimes enormously enlarged, 
however, the condition is not dangerous to life. It may 
be distinguished from hernia by the slowness of its forma- 
tion; by recent cases showing a translucency when the 
scrotum is held between the observer and a lighted lamp, 
and by its size not being increased by coughing. 

Treatment: Remove the fluid with a trocar and 
canula or an aspirator and before the canula or needle 
is withdrawn inject Tr. of Iodine into the scrotum, in 
order to produce an adhesive inflammation. After in- 
jecting the Iodine the opening in the canula should be 
closed until the scrotum is thoroughly manipulated for the 
purpose of bringing the remedy into contact with all the 
recesses of the sack; when, the Iodine must be allowed 
to escape and the canula be withdrawn. Usually this 
treatment is all that is required to make a permanent cure. 

In children a cure may be frequently affected by a 
thorough course of Apocynum Cannabinum and Acetate 
of Potash. 

ANASARCA. 

GENERAL DROPSY. 

Anasarca, or general dropsy is an accumulation of a 
watery fluid in the areola texture of the body; character- 
ized by swelling or pumness, usually commencing in the 
lower extremities, and pitting under pressure. 

General dropsy may be produced by a variety of causes, 
such as diseases of the heart, liver, kidneys, and spleen. 



2i 4 THE PRACTICE OF MEDICINE. 

It may also follow attacks of fever, inflammation, 
severe hemorrhages, obstructed menstruation, the excessive 
use of alcoholic liquors, etc. ' 

Symptoms : The first symptom of a general dropsy is, 
usually, a swelling of the feet and ankles, which is worse 
of an evening, especially in those who have remained 
on the feet the greater part of the day. When the recum- 
bent position has been assumed for several hours, the 
swelling subsides, in some cases, entirely for the time. 
The swelling is soft, inelastic and pits upon pressure 
being applied; and the skin is paler than is natural and 
has a glistening appearance. As the quantity of fluid 
increases the swelling becomes greater and extends 
upwards, finally reaching the body; and when the 
amount of fluid is great the face and eyelids are swollen, 
especially on arising in the morning. In some cases, the 
fluid oozes out through the skin, while in others, there are 
elevations on the skin resembling blisters. 

The pulse becomes small and weak; the bowels con- 
stipated; the urine scanty and high-colored, usually 
depositing a sediment on standing ; the appetite impaired ; 
thirst increased and the skin pale and inelastic. As the 
disease advances the patient becomes greatly debilitated; 
and the skin assumes a livid hue and there is frequently 
more or less fever. When the accumulation of fluid 
becomes general, there is a cough with the expectoration 
of a watery material and difficulty in breathing. Where 
relief is not obtained these symptoms grow worse day by 
day until death closes the scene. 



GOITRE. 215 

Treatment : Discover the cause and remove it, if 
possible, and, then, adopt the treatment recommended 
for dropsy of the heart. Where the spleen is enlarged 
appropriate treatment must be given for its relief. Con- 
trol fever, when present, by the administration of seda- 
tives according to indications. 

GOITRE. 

BIG NECK. 

Goitre, or bronchocele, as it is sometimes called, is 
an enlargement of the thyroid gland; characterized by a 
gradual enlargement of the gland followed by more or 
less pain and discoloration of the cuticle covering it. 

The uses of the gland are unknown. It covers the 
front and lower part of the larynx as well as the first rings 
of the wind-pipe. 

The disease is more common in Europe, especially 
in the deep valleys of the Alps than in America, however, 
cases of it are occasionally seen on all parts of the globe. 
Females are more subject to it than males; and it is not 
infrequently associated with diseases of the reproductive 
organs. 

Symptoms: These are a gradual enlargement of the 
gland, which is at first soft and without pain or discolor- 
ation of the skin, but as the gland increases in size it 
becomes more or less hard and painful and the skin 
covering it becomes discolored. The enlargement is 
sometimes so great that it interferes with breathing. 

Goitre is sometimes associated with what is known 
as cretinism, a condition of mental and bodily weakness. 



216 THE PRACTICE OF MEDICINE. 

Treatment : The following will sometimes relieve 
recent cases. 

Iodide of Potash, i ounce, 

Compound Syr. Stillingia, to make, . . 6 ounces. 

Mix and give a teaspoonful after ea*ch regular meal. 
At • the same time paint the tumor every few days with 
Tr. of Iodine. 

Operative procedures are recommended by some, 
while others recommend electrical treatment, but the 
great majority of cases, of long standing, are incurable 
by any method of treatment, however, life is not usually 
endangered or shortened by the disease. 



PART V. 

DISEASES OF THE DIGESTIVE APPARATUS. 

In this part of the work diseases of the mouth, 
oesophagus, stomach, intestines, liver and pancreas will 
be considered. 

STOMATITIS. 

INFLAMMATION OF THE MOUTH. 

Stomatitis is an inflammation of a whole or a part of 
the mucous membrane of the mouth; characterized by 
heat, pain, redness, and more or less swelling. 

Its most common causes are the introduction of hot 
or irritating substances into the mouth, difficult dentition, 
and it is not an infrequent complication of the eruptive 
or other fevers. The chronic variety of the disease usually 
results from the excessive use of alcoholic liquors or 
tobacco, therefore, it is rarely seen in children. 

Symptoms: Stomatitis begins with more or less heat 
and pain followed by redness and slight swelling of the 
mucous membrane of the mouth and tongue. In some 
cases, there is dryness of the mouth, while in others, there 
is a copious flow of saliva. The child is uneasy, fretful 
and cross and suffers considerable pain while eating or 
nursing. 

ai7 



218 THE PRACTICE OF MEDICINE. 

There may be a derangement of the bowels, and if 
the child is suffering from difficult dentition slight fever 
is not uncommon. 

Treatment: The treatment required in these cases 
is usually very simple. If there is fever control it with 
sedatives administered according to indications; and, if 
there is irritation of the stomach, or diarrhoea, appropriate 
remedies for the condition must be used. 
The following is efficient : 

Chlorate of Potash, i drachm, 

Carbolic Acid, 10 drops, 

Water, 4 ounces. 

Mix and wash the mouth thoroughly by means of a 
soft, cotton mop, every two or three hours, or: 

Borax, i drachm, 

Honey, i ounce, 

Infusion of Sage, 3 ounces. 

Mix and use as the preceding. 

In severe cases, Silver may be used as follows: 

Nitrate of Silver, .3 grains, 

Water, 1 ounce. 

Mix and use every three or four hours with a soft mop. 
Hydrastis Canadensis also makes a valuable wash 
in these cases. One ounce of the Fl. Ext. of it may be 
added to 3 ounces of water and used as a wash. 

FOLLICULAR STOMATITIS 

APHTHA, OR THRUSH. 

This is an inflammation of the mucous membranes 
of the mouth, associated with, or resulting from the 



FOLLICULAR STOMATITIS. 219 

growth of a parasitic plant, the oidium albicans; char- 
acterized by more or less disturbance of the stomach and 
bowels, slight fever and the formation of small white 
patches, or spots, on an inflamed base. . 

The most common causes of it are improper or 
unwholesome food, impure air and uncleanliness. 

Symptoms: The first symptom that attracts our 
attention is the sore mouth; and upon examination small, 
white points or patches will be found upon the mucous 
membrane, their base being red and swollen. The mouth 
is sometimes so tender that it is with difficulty that the 
child can eat or nurse. In some instances, especially 
in severe cases, the greater part of the mouth is involved, 
and there is usually more or less fever, irritation of the 
stomach and irregularity of the bowels. 

Treatment: When fever is present control it with 
sedatives administered according to indications. If the 
bowels are constipated, which is rarely the case admin- 
ister Oil or Salts; and if the child is being raised by hand 
keep its nursing bottle scrupulously clean. 

If the stomach is irritable remedies for its relief must 
be used; and if diarrhea is present it must receive appro- 
priate treatment. 

The following answers a good purpose in these cases* 

Chlorate of Potash, 1 drachm, 

Carbolic Acid, 10 drops, 

Water, 4 ounces. 

Mix and apply to the mouth with a cotton mop every 
two or three hours, or: 



220 THE PRACTICE OF MEDICINE. 

Sulphite of Soda, 4 drachms, 

Water, 4 ounces. 

Mix and use as the preceding prescription is di- 
rected, or: 

Boracic Acid, 1 drachm, 

Water, 4 ounces. 

Mix and use as the preceding. 

In severe cases it may be necessary to touch the 
patches with Nitrate of Silver and afterwards use a solu- 
tion of it of the strength of 5 grains to the ounce of water. 
If the patient is debilitated the following tonic should 
be given: 

Fl. Ext. of Nux Vomica, 1 drachm, 

Fl. Ext. of Hydrastis Can., 2 J drachms, 

Fowler's solution of Arsenic, \ drachm, 

Aromatic Elixir, sufficient to make, . 2 ounces. 
Mix and to a child one year old give 5 drops three 
times a day before meals. 

ULCERATIVE STOMATITIS. 

ULCERATIVE INFLAMMATION OF THE MOUTH. 

Ulcerative stomatitis is an acute inflammation of the 
mucous membrane of the mouth, continuing until there 
is an extensive, unhealthy, ulceration; characterized by 
heat and pain, in the mouth; enlargement and tenderness 
of the submaxillary glands with an increased flow of saliva 
mixed with blood, shreds, etc. It is a disease of child- 
hood, but adults are not exempt from it. 

The causes of it are thought to be personal unclean- 
liness, poor food and unhealthful surroundings, however, 



ULCERATIVE STOMATITIS. 221 

it is occasionally seen in ■ those who are in good circum- 
stances. 

Symptoms: The disease usually commences in the 
gums, which become red, swollen, and bleeding, and are 
soon covered with a grayish, membranous formation. 
The inflammation and ulceration extend to the corre- 
sponding portion of the membrane lining the mouth and 
lips, commencing with small, whitish spots, which enlarge 
and run together until they form large, grey patches, 
covering the erosion or ulceration. Usually the ulcer- 
ation is circumscribed, but occasionally it extends to all 
parts of the mouth. If not checked the inflammation 
continues and the ulceration deepens, the greyish layers 
of false membrane are detached, when, they are quickly 
renewed, thus perpetuating the disease. 

In severe cases the submaxillary glands are swollen, 
hard and painful, and the breath is offensive. The suf- 
fering is severe; the child restless, uneasy and unable to 
eat or nurse. More or less fever, with a quick, weak 
pulse, loss of appetite and emaciation is usually present. 
Sometimes the ulceration is so extensive that tne teeth 
are loosened and in rare instances fall out. 

Treatment: If the treatment is commenced early 
Chlorate of Potash in from 1 to 5 -grain doses every four 
hours and at the same time using a wash of a saturated 
solution of the same will usually be all that is required 
in these cases. 

The following also makes a valuable local application 
in these cases: 



222 THE PRACTICE OF MEDICINE. 

Tannin, 4 drachms, 

Water, 4 ounces. 

Mix and apply thoroughly with a soft mop every two 
or three hours. 

Where the ulceration shows a tendency to spread the 
following should be used : 

Nitrate of Silver, 10 grains, 

Water, 1 ounce. 

Mix and apply two or three times a day by means of 
a soft mop. Should these means fail to check the disease 
the ulcers must be penciled once a day with pure Nitrate 
of Silver. 

When fever is present, it should be controlled with 
sedatives administered according to indications. 

Diarrhoea when present, should be relieved with ap- 
propriate remedies and if the stomach is irritated it must 
be relieved. 

If the patient is debilitated after the fever subsides 
administer the following tonic: 

Fl. Ext. of Nux Vomica, 1 drachm, 

Fl. Ext. of Hydrastis Can., 2 \ drachms, 

Fl. Ext. of Gentian, 1 ounce, 

Aromatic Elixir, sufficient to make. . 2 ounces. 
Mix and, for a child three years old, give 10 or .12 
drops before each regular meal. 

GANGRENOUS STOMATITIS. 

GANGRENOUS INFLAMMATION OF THE MOUTH. 

This disease, also known as cancrum oris or noma, 
is an acute, rapidly progressive gangrenous ulceration of 



GANGRENOUS STOMATITIS. 223 

the cheek and gums. It is a disease of childhood, cases 
of it rarely occurring in the adult. All the preceding 
forms of inflammation of the mouth may terminate in 
gangrene, but none of them are so rapid or destructive 
in their effects as the form now under consideration. 

Feeble, sickly children, are more subject to the disease 
than others and it attacks girls more frequently than boys. 
Impure air, unwholesome food, and the excessive use of 
mercury are among its principal causes. It is not infre- 
quently secondary to measles, and an attack may follow 
scarlet fever, typhoid and typhus fevers, and pneumonia. 
It is believed by some to be due to a parasitic micro- 
organism, the character of which is unknown. 

Symptoms: "The symptoms vary; in some cases 
small vesicles of an ashy, dark-red, or even black color, 
are observed within the mouth, on the lips or cheek, 
encircled by a red base, with little pain or swelling, 
more or less salivation and a peculiar fcetor. These vesicles 
pass rapidly into a grangrenous condition, with an aug- 
mentation of the pain, heat and tumefaction. Dark 
or purplish spots appear in the region of the vesicles, which 
soon form large sloughs; and they progress so rapidly 
that in the space of forty-eight hours, all the fleshy parts 
of the mouth and face may be destroyed by the gangrenous 
action. In other instances, the ulceration commences 
on the gums, which at first present a white and spongy 
appearance, but which rapidly passes into ulceration 
and gangrene, also spreading and involving the jaws, 
cheeks and lips. The breath becomes intolerably offen- 



224 THE PRACTICE OF MEDICINE. 

sive, the teeth fall out, the soft tissues swell, become hard 
and purple, ulceration with sloughing ensues, and the 
discharge from the diseased parts are usually so acrid as 
to excoriate the parts over which it is permitted to flow." 

"At first the general health does not appear to be 
much affected, but as the disease progresses and the soft 
tissues are destroyed, an irritative fever ensues, with loss 
of appetite, emaciation, diarrhoea, and death." — King. 

Treatment: This to be of any benefit must be heroic. 
As soon as the nature of the attack is determined the 
sloughing surface and the tissue immediately surround- 
ing it must be destroyed with strong Nitric Acid, however, 
before undertaking this procedure Chloroform should 
be administered by inhalation until the patient is thor- 
oughly anaesthetized. After the operation the mouth 
should be cleansed with the following: 

Peroxide of Hydrogen', i ounce, 

Water, 2 ounces. 

Mix and apply every two or three hours. 

The following also makes "a valuable wash in these 
cases : 

Permanganate of Potash, 10 grains, 

Water, 2 ounces. 

Mix and use with a soft mop every two or three hours. 

Keep the bowels moderately open from the beginning 
of the attack; and if there is fever administer sedatives 
according to indications, adding the Fl. Ext. of Echinacea. 
Should diarrhoea occur control it with appropriate rem- 
edies. 



GLOSSITIS. 225 

When the patient becomes weak, stimulants, such 
as Whiskey, Brandy, or Aromatic Spirits of Ammonia, 
should be administered. 

The diet must be of the most nutritious character; 
and after convalescence is established the following tonic 
should be given : 

Fl. Ext. of Nux Vomica, 1 drachm, 

Fl. Ext. of Hydrastis Can., 2 J drachms, 

Fl. Ext. of Gentian, 1 ounce, 

Aromatic Elixir, sufficient to make, 2 ounces. 
Mix, and for a child three years old give 10 or 12 drops 
before each regular meal. 

GLOSSITIS. 

INFLAMMATION OF THE TONGUE. 

Glossitis is an inflammation of the substance (paren- 
chyma) of the tongue; characterized by more or less 
fever, heat, pain and swelling, with an increased flow 
of saliva, difficulty in mastication, deglutition and speech. 
There are two varieties; the acute and the chronic. 

Acute glossitis usually results from mercurial poison- 
ing, or direct injury to the tongue, such as the taking of 
hot liquids, acrid or corrosive substances into the mouth. 
It may also result from the sting of insects, such as the 
wasp or bee. 

Chronic glossitis usually occurs in patches along the 
edges of the tongue. It may follow the acute variety, 
or it may result from diseased teeth, smoking, especially 
the pipe, and it may occur in the aged without any 
apparent cause. 



226 THE PRACTICE OF MEDICINE. 

Symptoms: Acute inflammation of the tongue usually 
begins abruptly with fever, restlessness, anxiety and swell- 
ing of this organ, accompanied by heat, pain and an 
increased flow of saliva. The glands at the angles of the 
jaw become swollen and tender, and the tongue so greatly 
swollen that it sometimes protrudes from the mouth. 

Movements of the tongue in talking, chewing or swal- 
lowing, produce intense pain, and there is, in some cases, 
difficult breathing and an inability to lie down, on 
account of an obstruction to the free entrance of air into 
the lungs. The veins of the neck are sometimes com- 
pressed; in these cases there is blueness of the face and 
the patient may die from suffocation. When the inflam- 
mation terminates in suppuration, the constitutional symp- 
toms usually become more severe. 

In chronic inflammation of the tongue the chief symp- 
tom is pain or aching, which is not infrequently aggra- 
vated by movements of this organ. 

Treatment: Acute inflammation of the tongue de- 
mands prompt treatment. The fever should be controlled 
with the proper sedatives and the bowels kept moderately 
open with Oil, Salts or Seidlitz Powders. 

Ice should be kept constantly applied to the tongue 
and also at the angles of the jaw. If the ice is not at 
hand, hot water which has had i drachm of the Fl. Ext. 
of Pinus Canadensis, or 10 to 20 grains of Tannin added 
to each ounce should be held in the mouth; and cloths 
wrung out of hot water should be applied to the angles 
of the jaw. 



TONSILLITIS. 227 

If the case is a severe one, and the swelling great, the 
tongue should be scarified. If an abscess forms, it should 
be promptly opened; and if suffocation is imminent, 
tracheotomy (an operation in which there is an opening 
made in the wind-pipe for the purpose of allowing air 
to enter and leave the lungs) should be performed at once. 
In chronic inflammation of the tongue, if possible, 
remove the cause and avoid all irritants, such as tobacco 
and alcoholic liquors; and use the following: 

Nitrate of Silver, 10 grains, 

Water, 1 ounce. 

Mix and apply twice a day by means of a soft mop; 
or the parts may be cauterized every two or three days 
with stick-Nitrate of Silver. 

TONSILLITIS. 

QUINSY. 

Tonsillitis, or quinsy, is an inflammation of the tonsils; 
characterized by fever, pain in the throat, difficulty in 
breathing and swallowing, and a guttural cough with a 
constant desire to clear the throat. 

When small ash-colored spots appear on the tonsils 
the disease is known as follicular tonsillitis. Many phy- 
sicians call this form of the disease diphtheria, thus 
unnecessarily alarming parents and friends. 

The causes of it are changeable weather, exposure 
to cold or damp. Strumous persons are more subject 
to it than others. One attack predisposes to another. 
Rheumatism is preceded by tonsillitis in probably 30 
per cent of attacks of that disease. The presence of strep- 



22% THE PRACTICE OF MEDICINE. 

tococci and staphylococci has been detected, especially 
in the follicular form of the disease, and where there was 
the formation of pus in the tonsils. 

Symptoms: An attack usually commences with a 
chill, which is soon followed by fever, quickened pulse, 
soreness and stiffness of the throat, headache, thirst, pain 
and swelling at the angles of the jaw, a guttural cough 
and a constant desire to clear the throat. There is usually 
pain and difficulty in breathing and swallowing and some 
patients complain of ear-ache and more or less deafness. 
If the throat is examined the tonsils will be found red 
and swollen, sometimes to such an extent that the opening 
of the fauces is almost entirely closed. 

An attack usually lasts from a few days to a week, 
and either terminates by resolution or suppuration. When 
the disease terminates in suppuration the gland enlarges 
rapidly, the pain becomes dull and throbbing. The pus 
usually comes to the surface and is discharged without 
surgical aid, but a cure is materially hastened by incising 
the gland, thus giving free exit to the pus. 

An acute attack is not infrequently followed by the 
chronic form of the disease, especially in those who are 
predisposed to tonsillitis. In these cases the glands, on 
examination, appear prominent, enlarged, and of a dusky, 
red-color; and there is more or less cough caused by the 
irritation and sometimes an elongation of the uvula. 

Treatment: The treatment of this, as all other 
diseases in which there is fever, should be commenced 
by the administration of sedatives according to indica- 



TONSILLITIS. 229 

tions. If there is a full, quick pulse, give Veratrum or 
Aconite, and if the face is flushed, the eyes bright and 
the pupils contracted, add Gelsemium. Phytolacca (Poke 
Root) is also a valuable remedy in tonsillitis and should 
be added to the sedative, as follows: 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Fl. Ext. of Phytolacca Decandra, .18 drops, 

Water, 18 teaspoonfuls. 

Mix, and give a teaspoonful every hour and a half 
while there is fever, allowing the patient no water for 
a few minutes after taking a dose, thus obtaining the local 
effect of the remedies on the tonsils. 

In all cases where the stomach is irritated, Aconite 
should be used instead of the Veratrum and if the patient 
is stupid, the pupils being too large, add Belladonna in- 
stead of the Gelsemium, as follows: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, * . . . 6 drops, 

Fl. Ext. of Phytolacca Decandra,. 18 drops, 

Water, 18 teaspoonfuls. 

Mix, and give a teaspoonful every hour and a half 
while there is fever, allowing no water for a few min- 
utes after taking a dose. 

At the beginning of the attack, it would probably be 
well to administer the following: 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, 1 grain. 



230 THE PRACTICE OF MEDICINE. 

Mix and divide into five powders and give one of them 
every hour. Should they fail to act mildly on the bowels, 
give Oil, Salts or a Seidlitz Powder. 

Keep the bowels slightly open throughout the attack; 
either of the three last-named remedies may be used for 
this purpose. 

If there is scantiness of urine, give 20 grains of the 
Acetate of Potash, or 30 drops of the Fl. Ext. of Buchu, 
every three or four hours. 

The patient should inhale the steam from equal parts 
of vinegar and water a few minutes every two or three 
hours. 

Penciling the tonsils with Tr. of Veratrum Viride, 
every three or four hours, is very efficient as a local 
application. 

The following makes an efficient gargle: 

Tr. of Chloride of Iron, 1 drachm, 

Chlorate of Potash, 1 draChm, 

Glycerine, 1 ounce, 

Water, sufficient to make 4 ounces. 

Mix and use as a gargle every three hours. In pre- 
paring this prescription dissolve the Potash in water, 
then add the Iron and Glycerine. 

The following is very efficient in these cases: 

Ammoniated Tr. of Guaiac, 1 ounce, 

Glycerine, \ ounce, 

Simple Syrup, sufficient to make 2 ounces. 
Mix and give a teaspoonful without water every three 
hours, instructing the patient to swallow it slowly. 



OESOPHAGITIS. 231 

Should pus form, as soon as fluctuation can be de- 
tected, the tonsil should be lanced;' however, the operator 
should be very careful not to incise an important blood- 
vessel. 

In follicular tonsillitis, in addition to the treatment 
already recommended, J of a grain of the Sulphide of 
Calcium should be given every four hours. 

The patient's diet should consist of milk, soups, beef- 
essence, eggs, etc., adding Whiskey if there is very much 
weakness. 

Where the inflammation becomes chronic the follow- 
ing will frequently effect a cure: 

Iodide of Potash, 1 ounce, 

Fl. Ext. of Phytolacca Decandra, . . 2 J drachms, 

Compound Syr. of Stillingia, to make, . 6 ounces. 

Mix and give a teaspoonful three times a day after 

meals. The remedy should be used from three to six 

months, however, it would be well to discontinue its use 

for ten days in each month. 

(ESOPHAGITIS. 

INFLAMMATION OF THE CESOPHAGUS. 

This is an inflammation of a part or the whole of the 
mucous membrane lining the canal leading from the 
mouth to the stomach; characterized by more or less 
fever, pain between the shoulders, or deep-seated under 
the sternum, thirst and difficulty in swallowing. It is a 
rare disease, and may be either acute or chronic. 

The usual causes of it are the passage of hot fluids 
or solids to the stomach; irritating drugs, corrosive poisons, 



232 THE PRACTICE OF MEDICINE. 

the excessive use of alcoholic liquors; or it may result 
from an extension of an inflammation of the parts either 
above or below it. 

Symptoms : These vary with the severity of the attack ; 
there is, however, more or less fever, pain, sometimes of 
a burning character, between the shoulders, or deep-seated 
under the sternum, and constant thirst. 

Swallowing, which is sometimes impossible, produces 
intense pain and is occasionally followed by vomiting. 
Paroxysms of coughing, with difficult breathing, are not 
uncommon in severe cases. When ulceration is present, 
food that is swallowed passes to the ulcer and is then 
forced back by spasmodic contraction of the oesoph- 
agus, the food acting as an irritant to the raw 
surface. 

In the chronic variety of the disease there is pain and 
difficulty only when solids are swallowed.- When ulcers 
exist there may be vomiting of a tough mucus streaked 
with blood, accompanied by symptoms of stricture of 
the oesophagus. 

Treatment: Should the inflammation be the result 
of a foreign body lodged in the throat, it should be 
removed at once ; and where corrosive drugs have been 
swallowed the proper antidote must be administered 
without delay. The fever must be controlled with seda- 
tives administered according to indications; however, 
in these cases Aconite is the preferable remedy. A weak 
solution of Carbolic Acid should also be given; it may 
be prepared as follows: 



STRICTURE OF THE (ESOPHAGUS. 233 

Carbolic Acid, 20 drops, 

Gum Arabic, 30 grains, 

Water, 4 ounces. 

Mix and give a teaspoonful every two or three hours, 
instructing the patient to swallow it very slowly. 

For the purpose of relieving thirst small pieces of ice 
may be held in the mouth. 

Where the pain is severe hypodermics of Morphine, 
sufficient to produce rest, must be given. 

Keep the bowels open from the beginning of the 
attack; this may usually be accomplished by means 
of enemas. 

All solid foods must be avoided, the diet consisting 
of milk, tea, soups, etc. 

STRICTURE OF THE (ESOPHAGUS. 

Stricture of the oesophagus is a narrowing of the canal 
that leads from the mouth to the stomach; characterized 
by difficulty in swallowing, more or less pain and ema- 
ciation. 

It may be the result of inflammation; the contraction 
of scars formed by the healing of ulcers ; or tumors may 
develop in the canal and produce obstruction. The 
lodging of foreign bodies, and the contraction of muscles, 
caused by irritation of the oesophageal mucous membrane 
may also temporarily produce it. 

Symptoms: The symptoms vary with the special 
cause producing the stricture and the degree of narrow- 
ing of the oesophagus. The first and most prominent 
symptom is a sense of obstruction to the passage of food, 



234 THE PRACTICE OF MEDICINE. 

which the patient refers to a certain point, or, an appar- 
ently healthy person may experience a painful pressure 
in attempting to swallow a larger quantity of food at once, 
than usual. Finally the swallowing of fluids becomes 
difficult and the patient observes that the time required 
for food to reach the stomach is prolonged. 

When stricture is due to cancer, difficulty 'in swallow- 
ing is usually the only symptom complained of, but when 
it is caused by corrosive poisons or a wound, pain is a 
prominent symptom from the onset. 

In many cases the oesophagus is dilated above the 
stricture and may contain a considerable quantity of the 
material which the patient has recently attempted to 
swallow. In these cases the material together with more 
or less mucus is regurgitated three or four hours after 
meals; and, if this material is alkaline, we may be certain 
that it does not come from the stomach. Emaciation and 
debility gradually increase until they become extreme 
and finally, in a majority of cases, death closes the scene. 

Treatment: The stricture should be gradually and 
methodically dilated with a flexible English bougie. To 
begin with, a No. 16 should be employed; after warming, 
and lubricating it with Glycerine, it may be carefully 
inserted into . the oesophagus until it has passed the stric- 
ture. Its use should be preceded by a spray of a four 
per cent, solution of Cocaine to prevent spasm of the 
muscles surrounding the canal. Where the stricture almost 
closes the canal it may be necessary to commence the 
treatment with a catgut-sound. The instrument should 



SUBACUTE GASTRITIS. 235 

be used daily, and at intervals of three or four days larger 
bougies should be tried 

When the patient is unable to swallow a sufficient 
amount of food, a Symonds tube should be passed into 
the stomach and through it liquid food may be intro- 
duced. 

Concentrated forms of food, such as raw eggs, beef- 
essence, rich soups, milk and infants' food may be 
administered. 

When it is impossible to introduce the bougie, rectal 
feeding will have to be resorted to, and if this does not 
maintain the patient's strength an operation for the pur- 
pose of allowing the admission of food into the stomach 
will have to be resorted to. If the stricture is near the 
mouth, the oesophagus should be opened below the stric- 
ture, but if near the stomach, an opening will have to 
be made into this organ. Before food is introduced into 
the stomach it should be thoroughly masticated by the 
patient. 

SUBACUTE GASTRITIS. 

MILD INFLAMMATION OF THE STOMACH. 

Subacute gastritis is a catarrhal inflammation of the 
mucous membrane of the stomach; characterized by 
slight fever, loss of appetite, nausea, with occasional 
vomiting, irregularity of the bowels and in severe 
attacks, dizziness. 

The causes of it are various; it may be caused by 
exposure as other inflammations; errors of diet; the swal- 



236 THE PRACTICE OF MEDICINE. 

lowing of liquids either too hot or too cold; the abuse of 
alcoholic* liquors; the eating of food which has begun 
to decompose; and it may occur as a complication of 
various diseases, such as malarial fever, scarlet fever, 
measles, small-pox, typhoid fever, etc. 

Symptoms: An attack usually commences with loss 
of appetite, heat, pain, and a sense of uneasiness in the 
region of the stomach, which is aggravated by taking 
food or liquids into this organ. The tongue is elongated 
and pointed, its tip and edges red; and as the disease 
advances there is considerable thirst; flashes of heat; 
more or less fever; and burning sensations in the palms 
of the hands and soles of the feet. Nausea with more or 
less vomiting is almost a constant symptom; the material 
vomited first consisting of undigested food, but after- 
wards of a colorless, ropy mucus, or mucus colored yel- 
lowish or greenish by bile. 

Vertigo, with pain in the back of the neck, is frequently 
met with, especially in severe cases, and is quite trouble- 
some, causing the patient great anxiety and depression 
of spirits. 

The bowels, in some cases, are loose, while in others 
they are constipated. 

The urine is usually scanty and high-colored. 

The disease usually terminates in a slow recovery in 
from a week to ten days. 

Treatment: If the bowels are constipated the treat- 
ment should be commenced by the administration of the 
following : 



SUBACUTE GASTRITIS. 237 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, 1 grain. 

Mix and divide into five powders and give one every 
hour. Should they fail to act on the bowels, use an 
enema or give Oil, Salts or a Seidlitz Powder. 

Fever, when present, should be controlled with Aco- 
nite, adding Gelsemium where there is flushed face, bright 
eyes and contracted pupils; or the Belladonna where 
the patient is drowsy, the pupils being too large. For 
its effect on the stomach small doses of Ipecac should 
also be added as follows: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, # 

Fl. Ext. of Ipecac, 9 drops, 

Water 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half 
while there is fever; or: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Fl. Ext. of Ipecac, 9 drops, 

Water, .18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half 
while there is fever. 

The nausea and vomiting may usually be relieved 
by the administration of a Creosote Compound Tablet 
every hour and the use of a Mustard-Plaster over the 
region of the- stomach. Should these means fail to quiet 
the stomach, see Irritation of the Stomach. 



238 THE PRACTICE OF MEDICINE. 

Great care should be exercised in feeding the patient 
even during convalescence. 

After convalescence is fully established the following 
will be found very beneficial in toning up the stomach: 

Fl. Ext. of Nux Vomica, 2 drachms, 

Fl. Ext. of Hydrastis Can., 6 drachms, 

FL Ext. of Gentian, 2 ounces, 

Fowler's Solution of Arsenic, \ drachm, 

Aromatic Elixir, sufficient to make, 4 ounces. 
Mix and give a teaspoonful three times a day before 
meals. 

ACUTE GASTRITIS. 

ACUTE INFLAMMATION OF THE STOMACH. 

This is a violent inflammation of the mucous, sub- 
mucous, and muscular coats of the stomach , with destruc- 
tion of its tissue; characterized by intense pain, nausea, 
persistent vomiting, usually of bloody mucus and what- 
ever may have been ingested, and great prostration. 

It is usually caused by ingestion of irritant or corrosive 
drugs, such as Carbolic Acid, Arsenic, Corrosive Sub- 
limate, Copper, the mineral Acids, etc., etc. 

Symptoms: Soon after swallowing the poison, the 
patient experiences a dull, uneasy feeling in the region 
of the stomach, wnich rapidly increases until there is 
deadly nausea, violent and persistent vomiting, first, of 
the contents of the stomach, afterwards, of blood or 
bloody mucus and shreds of the mucous membrane. 
Thirst becomes intense, and when water is given it 
increases the pain and vomiting. There is, in many cases, 



ACUTE GASTRITIS. 239 

high fever, a quick, thready pulse, and difficulty in swal- 
lowing, especially where the oesophagus is involved. 

The urine becomes scanty arid high-colored, and the 
bowels constipated; however, in some cases there may 
be diarrhoea. The foregoing symptoms soon give place 
to a condition of collapse, accompanied by constant hic- 
cough. The pulse grows weaker, hour by hour, until 
it can not be felt at the wrists; breathing is hurried, 
short and irregular; the surface of the body is cold and 
clammy; the mind remaining clear until a short time 
before death. 

Sometimes, though rarely, the symptoms of prostra- 
tion just mentioned are followed by reaction instead of 
death, and the patient slowly recovers, the stomach, how- 
ever, remaining crippled for life. 

Treatment: Ascertain, if possible, the nature of 
the poison and administer the proper antidote at once, 
after which the stomach should be thoroughly washed 
out by means of the stomach-pump' or tube. 

Administer a full dose of Morphine hypodermically 
at once and repeat the dose sufficiently often to control 
the pain. 

Ice should be applied to the. stomach, and in order 
to allay the thirst to some extent small pieces of it may 
be swallowed at frequent intervals. If the ice can not be 
obtained, apply hot cloths over the region of the stomach. 

From 10 to 30 grains of the Subnitrate of Bismuth 
should be given every hour and the patient required to 
remain perfectly quiet. 



240 THE PRACTICE OF MEDICINE. 

If the bowels become constipated, they may be moved 
by means of an enema of warm soap-suds. Nourish- 
ment should also be administered in this manner, allow- 
ing nothing in the way of food but milk and Lime- 
Water to enter the stomach. 

CHRONIC GASTRITIS. 

CHRONIC GASTRIC CATARRH. 

This is a chronic inflammation of the mucous mem- 
brane of the stomach; characterized by tenderness over 
the region of this organ; impaired appetite; imperfect 
and painful digestion with lowness of spirits. 

The most common causes of it are repeated attacks 
of the subacute variety; the excessive use of alcoholic 
liquors; over-eating, and the imperfect mastication of 
food, especially highly seasoned articles. 

Symptoms: There is usually more or less distress 
and pain in the region of the stomach, especially after 
eating or when pressure is made over this organ. The 
appetite becomes impaired; digestion imperfect and pain- 
ful ; • and gas frequently accumulates in the stomach, 
which, when passed by the mouth, is very offensive. 
The bowels are constipated, or if the intestines are 
involved there is diarrhoea. The urine is scanty and high- 
colored; the tongue coated with a whitish fur, the tip 
and edges being almost always red. 

The pulse is usually quick and small; the extremities 
cold, and if relief is not obtained, loss of flesh takes place 
more or less rapidly. There is, sooner or later, lowness 



CHRONIC GASTRITIS. 241 

of spirits, sleeplessness, occasional attacks of dizziness, 
and the patient may live a number of years in constant 
misery. 

Treatment: In chronic gastritis, as in all other 
diseases of the stomach, one of the most important things 
to be attended to is the regulation of the patient's diet. 
All articles of food containing a considerable amount of 
sugar, starch or fat, and those that produce an unpleasant 
sensation in the stomach, should be abandoned. A milk- 
diet should be enjoined, especially while the more urgent 
inflammatory symptoms are present. After these symp- 
toms have subsided, beef, eggs, oysters, and a few fresh 
vegetables, in small quantities, may be allowed. 

If there is nausea, give a Creosote Compound Tablet 
every hour, or instead of this, from 5 to 10 grains of the 
Subnitrate of Bismuth may be given every hour. See 
Irritation of the Stomach. 

A Compound Tar Plaster should be applied over the 
region of the stomach and worn almost constantly, 
removing it only when the parts become so sore that it can 
not be borne, and, then, only long enough for the irritation 
to subside. This should be continued until all tender- 
ness in the region of the stomach has disappeared. 

If the bowels are constipated, give 10 or 15 drops of 
the Fl. Ext. of Cascara Sagrada, three times a day, 
either increasing or diminishing the dose according to its 
effects on the bowels. 

When the irritation subsides, the following should 
be given: 



242 THE PRACTICE OF MEDICINE. 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Fowler's Solution of Arsenic,. . . i§ drachms, 
Aromatic Elixir, sufficient to make, 6 ounces. 
Mix and give a teaspoonful three times a day before 
meals. 

Should digestion be very feeble, from 15 to 60 grains 
of pure Pepsin should be taken with each meal. 

In order to avoid a relapse great care must be exer- 
cised in eating during convalescence. 

IRRITATION OF THE STOMACH. 

VOMITING. 

Vomiting is a symptom frequently met with, not only 
in inflammation of the stomach, but in many other dis- 
eases, and is sometimes quite troublesome, if not actually 
dangerous, therefore, a separate notice of it is given. 

Treatment: Apply a Mustard-Plaster over the region 
of the stomach; or cloths wet with the White Liniment, 
and if the bowels are constipated give the following: 

Calomel, 1 grain, 

Powd. Ipecac, 1 grain, 

Bicarbonate of Soda, 10 grains. 

Mix and divide into five powders and give one every 
hour. Where the bowels are not constipated the follow- 
ing may be used instead of the foregoing: 

Subnitrate of Bismuth, 48 grains, 

Oxalate of Cerium, 6 grains, 

Hydrochlorate of Cocaine, 1 grain, 



IRRITATION OF THE STOMACH. 243 

Creosote, 3 drops, 

Water, sufficient to make, 1 ounce. 

Mix and give a teaspoonful every hour. 

Creosote Compound Tablets are almost a specific 
for vomiting. One of them may be given every hour, 
as is necessary. They may be obtained at any first-class 
drug store. 

The Sulphate of Morphine in from J to J-grain doses, 
hypodermically, will give relief in many cases where 
everything else has failed. 

The following is also useful: 

Subnitrate of Bismuth, 36 grains, 

Oxalate of Cerium, 3 grains, 

Powd. Ipecac, 3 grains, 

Mix and divide into six powders and give one of them 
in a teaspoonful of strong Mint- Water every hour. 

Ice- Water, allowing a very small quantity at a time, 
is beneficial. 

Mint- Water, as a drink at frequent intervals, "is- also 
useful. 

Lime-Water, in tablespoonful doses every two or 
three hours, answers a good purpose. 

Purified Charcoal (Carbo Ligni) in from 5 to 10- 
grain doses .every hour or so as the occasion demands, 
is efficient. 

Allow no food, and, water very sparingly, until the 
stomach is relieved. If there is danger of starvation, 
liquid food may be administered by enemas. 



244 THE PRACTICE OF MEDICINE. 

GASTRIC ULCER. 

ULCERATION OF THE STOMACH. 

Gastric ulcer is a solution of continuity of a portion of 
the mucous membrane and other tissues of which the 
walls of the stomach are composed; characterized by 
pain, tenderness, disorders of digestion, and more or less 
vomiting of blood. 

Its causes are not very well understood, however, 
the principal cause is probably an obstructed circulation 
of blood in the walls of the stomach. 

It may result from blows over the region of the 
stomach, tuberculosis, syphilis, burns of the integument, 
disorders of menstruation, etc. It is more common 
in young females than in others; 

Symptoms: These are indigestion; constant pain at 
the "pit of the stomach," which is increased by taking 
food, especially of an irritating character; tenderness of 
the stomach and more or less vomiting. If the ulcer 
is located near the cardiac orifice of the stomach, the 
vomiting occurs soon after eating, but if it is near the 
pylorus, it occurs an hour or so afterwards. The ejected 
matter may consist of indigested particles of food or 
simply acrid mucus. Vomiting of large quantities of 
bright-colored blood is almost a positive symptom of 
gastric ulcer. Where the blood remains in the stomach 
a considerable time before being ejected it may be dark 
in color. 



GASTRIC ULCER. 245 

The general condition of patients afflicted with gastric 
ulcer is variable; some, are greatly emaciated, while the 
nutrition of others is not much impaired. 

The ulcer is usually slow in forming, the average dura- 
tion being probably about a year; however, cases are 
recorded in which the disease developed suddenly and 
resulted in perforation of the stomach, peritonitis and 
death within two weeks, but such cases are exceedingly rare. 

With proper treatment the majority of cases recover. 
The dangers are perforation, peritonitis and fatal hemor- 
rhage, death, however, from the latter being rare. 

Treatment: Give the stomach as near absolute 
rest as possible. This may be accomplished to a great 
extent by requiring the patient to maintain the recumbent 
posture in bed and rectal alimentation. When this method 
of feeding fails to give satisfactory results the diet must 
consist of milk and Lime-Water. The proper amount 
of milk is 3 or 4 ounces every three or four hours. Sugars 
and starches must be avoided. 

Pain may be controlled with small doses of the Sul- 
phate of Morphine as is required. 

Vomiting may usually be relieved by from 10 to 30- 
grain doses of the Subnitrate of Bismuth. See Irritation 
of the Stomach. 

Should hemorrhage occur give the following: 

Fl. Ext. of Ergot, 4 drachms, 

Fl. Ext. of Rhus Aromatica, 4 drachms. 

■Mix and give a half teaspoonful every half-hour or 
hour as the urgency of the case demands. The Acetate 



246 THE PRACTICE OF MEDICINE. 

of Lead is also an efficient remedy in controlling hemor- 
rhage of the stomach. It may be given in from i to 5- 
grain doses. Where the stomach is very irritable the 
Fl. Ext. of Ergot, administered hypodermically, in from 
10 to 20-drop doses is probably our most efficient remedy 
for controlling hemorrhage of the stomach. 

For the ulcer 1 or 2 drops of Fowler's Solution of 
Arsenic should be given every five or six hours. The fol- 
lowing also gives good results in these cases: 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Echinacea, Angust.,...2 ounces, 
Fowler's Solution of Arsenic, . . .i\ drachms, 
Water, sufficient to make, 6 ounces. 

Mix and give a teaspoonful four times a day. 

If the bowels are constipated from 20 to 30 grains of 
the Phosphate of Soda should be given each night, as is 
required, and the patient instructed to form the habit of 
going to stool at a certain hour each day. 

Should perforation occur Morphine should be given, 
perfect quietude enjoined and a competent surgeon called 
at once, as an operation offers the only hope. 

Persons afflicted with ulceration of the stomach should 
live very temperate lives. 

GASTRIC CARCINOMA. 

CANCER OF THE STOMACH. 

Cancer of the stomach is a peculiar malignant growth 
usually occurring near the outlet (pylorus) of the stomach, 
destroying the tissues of this organ and involving the lym- 
phatic glands; characterized by symptoms of dyspepsia, 



GASTRIC CARCINOMA. 247 

pain, vomiting and a marked impairment of the general 
health. 

Males are more subject to it than females, and it is 
most frequently met with between the ages of forty-five 
and sixty- five. It is usually the result of an inherited 
predisposition and is always fatal. 

Symptoms: The symptoms of cancer of the stomach 
are rather similar to those of ulceration of this organ. 
The pain, however, is more violent, and the material 
vomited usually resembles coffee-grounds, very rarely, 
if ever, consisting of pure blood. 

Where the cancer is near the cardiac orifice (entrance 
to the stomach), there is usually vomiting soon after 
eating, and when near the pylorus (outlet), it occurs 
some hours after taking food. 

Pain of a dull heavy character, increased by pressure 
or food is almost a constant symptom. Swelling (oedema) 
of the ankles may occur as early as the third month, and 
progress to a general dropsy. 

The bowels become constipated, the patient anaemic 
and emaciated; the skin sallow or fawn colored; the lym- 
phatic glands, especially of the neck and groins, enlarge; 
and in a majority of cases a tumor, which is almost charac- 
teristic, may be felt in the region of the stomach. Jaun- 
dice and enlargement of the liver frequently occur, and 
there is not infrequently albumen in the urine. 

The average duration of the disease is about a year, 
the patient dying from exhaustion, peritonitis or hemor- 
rhage. 



248 THE PRACTICE OF MEDICINE. 

Treatment: The disease is incurable, therefore, all 
that can be done is to palliate, as much as possible, the 
patient's suffering and thereby smooth his pathway to 
the grave. 

When there is pain in the stomach from 10 to 20 grains 
of the Subnitrate of Bismuth may be given. Should this 
fail to afford relief, as it frequently will, give from J to J 
of a grain of the Sulphate of Morphine, preferably hypo- 
dermically. 

Where there is acidity of the stomach give the follow- 
ing: 

Carbolic Acid, 32 drops, 

Gum Arabic, 1 drachm, 

Water, 4 ounces. 

Mix and give a teaspoonful three times a day. 

The Fl. Ext. of Cascara Sagrada, in from 5 to 30- 
drop doses, or Phosphate of Soda in from 10 to 20-grain 
doses, should be administered two or three times a day, 
as is needed when the bowels are constipated. 

The persistent use of Fowler's Solution of Arsenic 
in 1 or 2-drop doses four times a day, is said to materially 
retard the development of cancer of the stomach, but this 
lacks confirmation. 

The diet should be administered in fluid form, select- 
ing such articles as the patient, from experience, has found 
to disagree with him the least. 

If the stomach will not tolerate food, rectal alimenta- 
tion (the introduction of liquid food, by means of a syringe, 
into the last intestine) will have to be resorted to. 



H^MATEMESIS. 249 

Stimulants must be avoided. See Hemorrhage of 
the Stomach. 

ELEMATEMESIS. 

HEMORRHAGE OF THE STOMACH. 

Hemorrhage of the stomach, strictly speaking, is not 
a disease, but a symptom, however, it is of sufficient im- 
portance to demand a separate notice. 

It may result from ulcer, or cancer, of the stomach, 
the swallowing of corrosive poisons, congestion of the liver 
or spleen, malarial fever, yellow fever, etc., or it may be 
vicarious at the menstrual period. 

Symptoms: In addition to the symptoms of the dis- 
ease causing it, there is, when the hemorrhage is rather 
free, coldness of the surface of the body, especially of the 
extremities, a feeling of warmth and distension in the 
stomach, which, when the hemorrhage is profuse, is fol- 
lowed by faintness or fainting, nausea and vomiting of 
blood. When the blood is immediately thrown out of the 
stomach, it is fluid and of a bright color, but when it 
remains in the stomach for a while it consists of dark- 
colored clots. 

Hemorrhage of the stomach may sometimes be con- 
founded with hemorrhage of the lungs. In the latter the 
blood is a bright red or scarlet and frothy; is coughed up 
not vomited, and there is usually symptoms of a lung- 
trouble. 

Treatment: Put the patient to bed and require 
him to remain perfectly quiet. Give from 10 to 30 drops 
of the Fl. Ext. of Ergot, preferably hypodermically every 



250 THE PRACTICE OF MEDICINE. 

half-hour or so as the urgency of the case demands. The 
following is also very efficient: 

Fl. Ext. of Ergot, 4 drachms, 

Fl. Ext. of Rhus Aromatica, 4 drachms. 

Mix and give a half-teaspoonful every half-hour or so 
until relieved. Ice internally and applied over the region 
of the stomach is also beneficial. The Sulphate of Mor- 
phine in v from J to J-grain doses, preferably hypodermic- 
ally, may also be administered in order to quiet the 
patient's fears. 

Should the foregoing means fail, give from 3 to 5 drops 
of Monsel's Solution of Iron (Liquor Ferri Subsulphatis) , 
largely diluted with water, every half-hour or so until 
relief is obtained. 

In these cases, the rectum (last intestine) should be 
substituted for the stomach and nutritious food, in a 
liquid form, introduced into it by means of a syringe for 
a few days. 

DYSPEPSIA. 

INDIGESTION. 

"Dyspepsia is a term applied to all conditions of 
imperfect digestion that are not dependent on changes of 
structure in the digestive organs. The causes of dys- 
pepsia are numerous, and the symptoms, consequently, 
vary greatly in different cases." 

"The secretion from the mucous membrane may be 
scanty, or too profuse; the gastric juice may be deficient 
or excessive, or changed in quality; the muscular move- 
ments may be impaired; the pancreatic and intestinal 



DYSPEPSIA. 251 

juices may be deficient in quantity and quality; or there 
may be an irritable or prostrated condition of the nervous 
system." 

Symptoms: A feeling of weight and tension in the 
region of the stomach, with a bad taste in the mouth, 
fceted breath, nausea, which may extend to vomiting, 
heavily coated tongue, sometimes a disgust for food, 
unpleasant eructations for several hours after eating, and 
alternating constipation and diarrhoea, are the symptoms 
that indicate an excessive secretion of mucus. 

Continued irritation of the stomach, heart-burn, both 
before and after eating, a feeling of soreness when the 
stomach is distended, and an annoying, contracted feel- 
ing when emptied, indicate a scanty mucous secretion. 
Irritation of the stomach, accompanied by slight pain 
and water-brash, indicate an increased secretion of the 
gastric juice. 

" Distention of the stomach, with an uneasy sensation 
of fullness, the rumbling of gases, the absence of pain, 
a general sluggish condition of the system, and continued 
constipation indicate impaired muscular action. A feel- 
ing of 'goneness' in the stomach with distress after 
eating, and great irritability that causes everything to be 
rejected as soon as swallowed, indicate derangement of 
the nervous system, which may be due to disease of the 
spinal cord." 

"From the deranged digestion that constitutes dys- 
pepsia, we necessarily have feeble and imperfect nutrition 
and derangement, to some extent, of all the functions of 



252 THE PRACTICE OF MEDICINE. 

the body. Loss of flesh and strength also ensues if the 
disease continues. The general symptoms of pain, burn- 
ing sensation and soreness in the stomach, tenderness 
on pressure, dragging weight and tension, always indicate 
the presence of some form of indigestion." — Gunn. 

Treatment: Regulate the diet. Prohibit saccharine, 
starchy, or fatty articles of food and also all other articles 
that the patient has found, by experience, disagrees with 
the stomach. Require him to eat very slowly and mas- 
ticate his food thoroughly. If he use tobacco, tea, or 
coffee, require him to use them very moderately or abandon 
them altogether. If the patient suffers with heartburn 
instruct him to eat no corn-bread until he is fully con- 
vinced that it is not the cause of the acidity. Forbid the 
use of alcoholic drinks in any form. 

Acidity of the stomach, or heart-burn, when present, 
may usually be relieved by io-grain doses of the Subnitrate 
of Bismuth administered at the time of the acidity. Should 
this fail, give 2 or 3 drops of Hydrochloric Acid, well 
diluted with water, half an hour before each regular meal. 
Where digestion is very feeble it may be aided by a 
full dose of Pepsin after each regular meal. 

The following is almost a specific in dyspepsia: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Tr. of Capsicum, 1 ounce, 

Fowler's Solution of Arsenic,. '. 48 drops, 

Aromatic Elixir, sufficient to make, . . 6 ounces, 



INTESTINAL DYSPEPSIA. 253 

Mix and give a teaspoonful before each regular meal. 

If the bowels are constipated give a sufficient amount 
of the Fl. Ext. of Cascara Sagrada, after each regular 
meal, to cause one action a day from the bowels, and 
instruct the patient to form the habit of going to stool at 
a certain hour each day. 

INTESTINAL DYSPEPSIA. 

INTESTINAL INDIGESTION. 

" As. only part of the process of digestion is completed 
in the stomach, this organ may be in a healthy condition 
and yet intestinal digestion may be impaired. 

The abuse of cathartic medicines, the continued use 
of indigestible articles of food and the irritating pro- 
ducts of stomach dyspepsia, act in producing this dis- 
order." 

Symptoms: '" Although sufficient food is taken and 
no trouble is felt in the stomach, yet the patient is not 
properly nourished, as is manifested by loss of strength 
and energy and continued constipation. When the 
bowels do move, the faeces are semi-fluid and irritating, 
the face is contracted and pinched, there is uneasiness 
about the navel, the skin is dry and harsh, the pulse fre- 
quent, the urine scanty and the nervous system irritable." 
— Gunn. 

Treatment: Regulate the bowels with the Fl. Ext. 
of Cascara Sagrada or the Phosphate of Soda; knead 
the abdomen every day and adopt the treatment recom- 
mended for dyspepsia of the stomach. 



254 THE PRACTICE OF MEDICINE. 

GASTRALGIA. 

NEURALGIA OF THE STOMACH. 

Neuralgia of the stomach, or stomachic colic, as it is 
sometimes called, is a painful condition of the sensory 
nerves of this organ; characterized by paroxysms of ex- 
cruciating pain, feebleness of the heart's action, coldness 
of the extremities and symptoms of collapse. 

It may be induced by errors in diet, exposure to cold, 
fatigue, malaria, cancer, or ulcer, anaemia, and a rheuma- 
tic or gouty diathesis. Dr. Loomis says: "Hysteria and 
hypocondriasis are its two most frequent causes." 

Symptoms: It usually commences with a. feeling of 
fullness or tightness in the stomach, followed by parox- 
ysms of pain of the most excruciating character. 

During these paroxysms the heart's action, in severe 
cases, becomes weak and irregular, the extremities cold, 
the countenance pinched, and there are symptoms of 
fainting. Convulsions sometimes occur, however, this 
is rare. Tenderness in the region of the stomach is not 
common, in fact, the . pain is generally relieved to some 
extent by firm pressure. 

An attack usually lasts from a few minutes to one or 
two hours, the pain gradually subsiding, or the attack 
terminates abruptly with eructations of gas, or the 
vomiting of an acid or alkaline fluid. 

These attacks are liable to recur, from time to time, 
but are not generally considered dangerous to life. 

Treatment: The \ of a grain of the Sulphate of 
Morphine will promptly relieve the pain, especially when 



INTESTINAL COLIC. 255 

administered hypodermically. Laudanum, or Paregoric 
is also efficient. In the absence of any or all of these, 
Pepper or Ginger may be used, however, these are far 
inferior to the preparations of Opium just mentioned. 
In all cases apply cloths, wrung out of water, as hot as 
can be borne. 

If the pain comes on periodically Quinine should be 
given as in common chills. 

If the patient is anaemic give the following tonic: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fowler's Solution of Arsenic, 48 drops, 

Aromatic Elixir, sufficient to make, 6 ounces. 
Mix and give a teaspoonful before each regular 
meal. 

If the bowels are constipated, they must be regulated, 
and if there is a rheumatic or gouty diathesis, appropriate 
remedies for these diseases should be given. The diet 
should be well regulated and exposure of every variety 
avoided. 

INTESTINAL COLIC. 

COLIC. 

Colic is a spasmodic contraction of the muscular layer 
of the walls of the intestines; characterized by. severe, 
paroxysmal, griping pains in the umbilical region with 
more or less constipation and vomiting. 

Several varieties of the disease were formerly recog- 
nized by medical writers, but as these with the exception 
of lead colic, which will receive a separate notice, are only 



256 THE PRACTICE OF MEDICINE. 

different grades of the same affection, this classification 
is commonly disregarded by modern authorities. 

The 'most common causes of colic are the presence of 
acrid or indigestible food, irritating secretions, the accu- 
mulation of gas in the intestinal canal, and constipation, 
especially in those who are not accustomed to this condi- 
tion. 

Symptoms: " There are attacks of pain, spreading 
from the navel over the abdomen, alternating with inter- 
vals of ease. The pain is tearing, cutting, pressing, most 
frequently twitching, pinching, accompanied by peculiar 
bearing-down pains. The patient is restless and seeks 
relief in changing his position and in compressing the 
abdomen; his surface may be cold and his features 
pinched. The pulse is small and hard. The abdomen 
is tense, whether puffed up or drawn inward. There 
are often nausea and vomiting, and a desire for stool. 
There is usually constipation, but sometimes the bowels 
are regular or even too loose. Duration from a few min- 
utes to several hours, relaxing at intervals. The attack 
ceases suddenly, with a feeling of the greatest relief, 
although some soreness remains for a few days." — 
Romberg. 

Treatment: First, relieve the pain. This may be 
accomplished by the administration of \ of a grain of the 
Sulphate of Morphine. The relief will be more prompt 
if the Morphine is used hypodermically. Laudanum, 
Paregoric or Dover's Powder may also be used for the 
relief of pain in these cases. If none of these remedies 



COLICA PICTONUM. 257 

are at hand hot teas, such as Capsicum and Ginger may 
be used. Cloths wrung out of hot water should be ap- 
plied to the abdomen and changed as they become cool. 

If the bowels are constipated, Oil or Salts should be 
given as soon as the pain is relieved. Care in eating 
should be exercised for a few days. 

COLICA PICTONUM. 
painter's or lead colic. 

Painter's or lead colic is the result of poisoning by 
lead; characterized by slate-colored skin, a sweetish, 
metallic taste, obstinate constipation, impaired appetite, 
slow pulse, scantiness of urine, severe pain in the abdo- 
men, paralysis or dropping of the wrists, and a bluish 
line along the edge of the gums. 

The cause of it is the presence of a sufficient amount 
of lead in the system to act as a poison. It may enter 
the system through the stomach or the skin. Painters 
and persons employed in smelters and the manufacture 
of lead-paints are more subject to it than others, how- 
ever, lead-poisoning has been repeatedly produced by 
sleeping in newly painted rooms, using water from lead 
pipes or vessels lined with lead. 

Symptoms: In addition to the symptoms of ordinary 
colic, in this, the pain is more severe, comes on gradually, 
and frequently extends to the back, upper extremities, 
hips, thighs and legs. The abdominal walls are tense, 
hard and knotted, the umbilicus (navel) frequently drawn 
upward. The bowels are obstinately constipated, but 



258 THE PRACTICE OF MEDICINE. 

not tender upon pressure, neither does pressure alleviate 
the pain. 

The skin is usually soft and moist and of a slate-color; 
the tongue broad and pale; a sweetish metallic taste in 
the mouth, and in a majority of cases there is a blue line 
along the edge of the gums, and a dropping of the wrists 
caused by paralysis of certain muscles of the forearm. 

An attack usually terminates in from two to fifteen 
days. 

Treatment: Relieve the pain as you would in or- 
dinary colic and then give Oil, Salts or Seidlitz Powders 
every three or four hours until free action from the bowels 
is obtained. 

In order to eliminate the lead from the system, give 
from 10 to 20 grains of the Iodide of Potash after each 
regular meal. 

A recurrence of the trouble may be prevented by 
avoiding the cause. 

Care should be exercised in eating during, and for a 
few days after an attack. 

CHRONIC CONSTIPATION. 

Constipation is a functional inactivity of the bowels; 
characterized by a change in the character and frequency 
of the stools. 

It may be due to diminished action of the muscular 
coat of the intestines, causing lessened peristalsis (worm- 
like motion), or to diminished intestinal and biliary secre- 
tions, or to both. The condition is not infrequently the 
result of indigestion, the habitual use of cathartic medi- 



DIARRHCEA. 259 

cine or opium, an improper quality and quantity of food, 
irregular habits of the patient, and lead-poisoning. 

Treatment: The diet of persons suffering with 
chronic constipation must be well regulated, a consider- 
able portion of each meal consisting of vegetables, ripe 
fruit, cooked fruit or vegetables. In many cases the 
bowels may be regulated by the diet alone. 

The patient must be instructed to go to stool at a cer- 
tain hour each day, and remain a sufficient time to allow 
a thorough evacuation of the bowels. These instructions 
must be rigidly enforced. 

The strict observance of the foregoing instructions, 
and the following, taken regularly, will usually result in 
a complete cure. 

Fl. Ext. of Nux Vomica, 2 drachms, 

Fl. Ext. of Belladonna, 48 drops, 

Fl. Ext. of Cascara Sagrada, 1 J ounces, 

Aromatic Elixir, sufficient to make . . 6 ounces. 

Mix and give a teaspoonful before each regular meal, 
either increasing or diminishing the dose according to 
its effects on the bowels. 

DIARRHCEA. 

"looseness of the bowels." 

The term, diarrhoea, is used to denote frequent, fluid 
or semi-fluid, discharges from the bowels, which is quite 
common during the warm season, especially among chil- 
dren. It is really only a symptom, and is met with in 
various diseases, but as it is considered in connection 



2<5o THE PRACTICE OF MEDICINE. 

with these, we will only notice two forms of it here: Diar- 
rhoea from irritation, and Diarrhoea from atony. 

Indigestion, indigestible food, unripe fruit, over-loading 
the stomach, excessive heat and age, seem to be the prin- 
cipal factors in inducing an attack. Children artificially 
fed are more subject to it than others, and those passing 
through their second summer are especially liable to it. 

Out of nearly 2000 fatal cases reported by Holt, 
only 3 per cent were exclusively breast-fed. Usually the 
disease has its origin in some error of diet. Bacteria 
have been found in the discharges, but this is no more 
than should be expected, as, wherever there is diseased, 
decaying, or dead matter, bacteria are sure to be present. 

Symptoms: In diarrhoea from irritation, the discharges 
from the bowels are green, or dark-colored, frequently 
containing more or less mucus and not infrequently blood. 
The discharges are sometimes so acrid that they inflame 
the parts with which they come in contact, especially 
when they have continued for some time. Uneasiness 
is usually manifested by the patient before having an 
action from the bowels, and there is some straining with 
the action. Fever, with a harsh, dry skin, and passive 
congestion of the brain, is quite common in these cases. 

In diarrhoea from atony, the discharges are light- 
colored, watery, frequently containing particles of 
undigested food, and are passed without pain or 
uneasiness. The discharges, in this, are usually 
larger than in the preceding variety, but the amount of 
solid material is not increased. Where the disease 



DIARRHCEA. 261 

persists for some time, the child becomes relaxed, the 
skin cool and soft, the extremities cold, the face pale, and 
the circulation weak. 

In both of the foregoing conditions, the appetite and 
digestion are impaired, and there is, consequently, loss 
of flesh and strength. 

Treatment: In diarrhoea from irritation, commence 
the treatment by the administration of a full dose of Oil. 
After the Oil has acted on the bowels put the patient on 
the following: 

Subnitrate of Bismuth, i\ drachms, 

Sulpho-Carbolate of Zinc, 48 grains, 

Powdered Bay Berry, 4 drachms. 

Mix and divide into sixteen powders and give one every 
three or four hours. Should this fail to check the bowels, 
give the following: 

Subnitrate of Bismuth, i\ drachms, 

Fl. Ext. of Bay Berry, \ ounce, 

Paregoric, sufficient to make, 2 ounces. 

Mix and give a teaspoonful every three hours. This 
preparation will become thick after standing and it may 
become necessary to use a wire or knitting needle to stir 
it before pouring out a dose. Every two or three days 
a full dose of Oil should be given, as at the beginning of 
the attack, and thus continued until a cure is effected. 

Control the fever with sedatives, administered accord- 
ing to indications as in any other disease. If there is a 
full, quick pulse, give Aconite and if the patient is sleeping 



262 THE PRACTICE OF MEDICINE. 

more than natural, sleeping with the eyes partly open, 
the pupils being too large, give Belladonna, thus: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half or 
two hours while there is fever. 

If the fever is periodic, give the following during the 
intermission or remission: 

Quinidine (alkaloid), i J drachms, 

Simple Syrup, sufficient to make, . . 2 ounces. 
Mix and give a teaspoonful every three hours when 
there is no fever. In adults the Sulphate of Quinine 
may be used instead of the Quinidine. 

In diarrhoea from atony give 3 or 4 drops of the Fl. 
Ext. of Nux Vomica three times a day, before meals and 
also the following: 

Podophyllin, .1 grain, 

Sugar of Milk, 1 drachm. 

Mix thoroughly and divide into thirty powders and 
give one of them every three hours until the color of the 
discharges change to normal, or green, then, treat as a 
diarrhoea from irritation. 

When the diarrhoea is controlled put the patient on 
the following tonic until his former health is regained: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fowler's Solution of Arsenic, 48 drops, 

Aromatic Elixir, sufficient to make, . .6 ounces. 



CHOLERA MORBUS. 263 

Mix and give a teaspoonful before each regular meal. 
These doses are for adults; see table of doses. 

CHOLERA MORBUS. 

Cholera morbus is an irritation of the mucous mem- 
brane of the stomach and bowels; characterized by vio- 
lent pain in the abdomen, constant vomiting and purg- 
ing, and cramping of the muscles of the abdomen and 
extremities. It is a disease of warm weather, cases of it 
being rarely seen during other seasons of the year. 

The most common causes of it are a fermentation 
of the food in the stomach and bowels, the eating of food 
in a state of fermentation, such as fruit, vegetables, 
"canned goods," etc. In a great majority of cases it is 
probably a result of ptomain poisoning. 

Symptoms: Cholera morbus usually makes its 
appearance with pain in the region of the umbilicus 
(navel), nausea, a feeling of prostration and a desire to 
evacuate the bowels. This is soon followed by almost 
incessant vomiting and purging. The discharges from 
the bowels are, at first, large, watery and feculent, but 
if the attack is severe, or protracted, the discharges soon 
partake of the character of the "rice-water" discharges 
of Asiatic cholera. The matter vomited, at first, con- 
sists of the ordinary contents of the stomach, but after- 
wards, of a watery material, which is sometimes mixed 
with bile. 

The pain in the bowels varies in different cases; in 
some, it is slight, while in others it is of the most excru- 
ciating character, and is attended with severe cramping 



264 THE PRACTICE OF MEDICINE. 

of the muscles of the abdomen, arms and lower extrem- 
ities. 

The urine is scanty and high-colored and frequently 
suppressed; the mouth dry, thirst intense, but water is 
rejected almost as soon as swallowed. The pulse is weak, 
quick, and, in severe cases, irregular; the patient is greatly 
exhausted; the skin cold, shrunken and frequently cov- 
ered with . a clammy perspiration. If relief is not 
obtained, the patient grows weaker hour by hour; the 
mind wanders; there are involuntary discharges from the 
bowels, and death soon closes the scene. This, however, is 
only an occasional termination of cholera morbus, as scarce- 
ly 5 per cent of the cases die under proper treatment. 

Treatment: The treatment of cholera morbus should 
be commenced by the hypodermic injection of \ of a grain 
of the Sulphate of Morphine, to be repeated in a half- 
hour if there is no improvement. In the absence of the 
hypodermic syringe, the dry Morphine may be placed 
on the back part of the tongue and swallowed. Should 
it be immediately rejected, the dose must be repeated at 
once, closely watching its effects; or if it is retained and 
no relief follows, in the course of thirty minutes, the dose 
must be repeated. In cases where the stomach will not 
retain the Morphine, i drachm of Laudanum mixed with 
two or three ounces of warm starch- water may be injected 
into the rectum (last intestine) immediately after an evac- 
uation from the bowels, and the patient instructed to 
retain it as long as possible. Should it be expelled the 
dose must be repeated. 



CHOLERA MORBUS. 265 

Chloroform is also an excellent remedy in these cases. 
The dose of it is from 15 to 30 drops, in sweetened water 
every twenty or thirty minutes. 

Fluids must be withheld as much as possible, how- 
ever, in order to quench the thirst to some extent, small 
lumps of ice or a teaspoonful of ice-water may be occa- 
sionally allowed. 

Cloths wrung out of hot water, should be applied to 
the stomach and bowels, and if the cramping in the ex- 
tremities is severe, friction with Mustard, will usually 
give relief. The Tr. of Dioscorea Villosa (Wild Yam) 
in 10 to 15-drop doses every half -hour, is highly recom- 
mended for the cramping of cholera morbus, but our 
success with it has not been flattering. 

Where the pulse becomes weak, stimulants, in the 
form of Whiskey or Aromatic Spirits of Ammonia should 
be given every half-hour, or oftener, as the condition of 
the patient demands. In addition to this, where the case 
is a very severe one, give from 1-40 to 1-30 of a grain 
of the Sulphate of Strychnine, preferably hypodermically, 
every two or three hours, and, at the same time, wrap 
the patient in a blanket wrung out of hot Mustard- 
Water. 

Should diarrhoea remain after the other symptoms 
have subsided, it may usually be relieved with the Sub- 
nitrate of Bismuth. Should this fail to give relief treat 
it as you would an ordinary diarrhoea. 

The diet must be carefully selected for a few days 
after an attack. 



266 THE PRACTICE OF MEDICINE. 

CHOLERA INFANTUM. 

Cholera infantum is an acute catarrhal inflammation 
of the mucous membrane of the stomach and intestines 
together with an irritation of the sympathetic nervous 
system occurring in children during warm weather; char- 
acterized by vomiting, purging, abdominal pain, fever, 
intense thirst, great emaciation and prostration. 

The most common causes of it are age, excessive heat, 
especially continuous, unwholesome food, and unsanitary 
surroundings. A majority of medical writers claim that 
teething is one of its principal causes, but, as this is a 
natural process, it, in all probability, has nothing what- 
ever to do with its production. 

Children passing through their second summer are 
especially liable to it; and it is more fatal in artificially 
fed children than in others. Out of 2000 fatal cases col- 
lected by Holt only. 3 percent, were exclusively breast-fed. 

Bacteriae of the proteus class are usually present in 
the discharges. 

Symptoms: In many cases an attack of cholera in- 
fantum is preceded a few days, sometimes a week or more 
by diarrhoea, the child being feverish and usually fretful. 
While in other cases, the attack commences suddenly 
with vomiting and purging, preceded by pains in the 
abdomen, and soon followed by fever, an accelerated 
pulse and intense thirst. 

The vomited matter, at first, consists of the ordinary 
contents of the stomach, but afterwards of a watery 
"mucus, which is frequently mixed with bile. 



CHOLERA INFANTUM. 267 

The discharge from the bowels is watery, frequently 
containing particles of undigested food and more or less 
mucus of a yellow or greenish color, and not infrequently 
streaked with blood. 

The fever is usually of a remittent type, the evening 
temperature commonly running quite high. The pulse 
is rapid, sometimes weak and irregular, and thirst is ex- 
treme, but when fluids are taken into the stomach they 
almost immediately excite vomiting. 

In this, as in all other diseases where there is fever, 
there may be, and frequently is, congestion of the brain; 
the passive being the form most frequently met with. 

These symptoms are attended by a rapid loss of flesh 
and strength; the eyes become sunken; the tongue red and 
dry, sometimes fissured, and bleeding; and, if relief is not 
soon obtained, the little patient passes into a stupor; the 
pulse grows weaker and weaker hour by hour; the skin 
becomes cold and clammy and death soon closes the 
scene. 

The duration of an attack is from a few days to as 
many weeks. 

Treatment: Control the fever with sedatives admin- 
istered according to indications, adding small doses of 
Ipecac, thus: 

Tr. of Aconite Root, 8 drops, 

Fl. Ext. of Ipecac, 4 drops, 

Water, 16 teaspoonfuls. 

Mix and give a half-teaspoonful every hour and a 
half or two hours while there is fever. If the patient 



268 THE PRACTICE OF MEDICINE. • . 

sleeps more than natural, the pupils being too large, Bel- 
ladonna should be added to the sedative, thus: 

Tr. of Aconite Root, 8 drops, 

Fl. Ext. of Ipecac, 4 drops, 

Fl. Ext. of Belladonna, 5 drops, 

Water, 16 teaspoonfuls. 

Mix and give a half - teaspoon ful every hour and a half 
or two hours while there is fever and keep the head cool 
and the feet warm. In addition to this give from 3 to 
5 -grain doses of Subnitrate of Bismuth, in Mint- Water, 
every two or- three hours. Apply a Mustard or Spice- 
poultice over the stomach. 

Should the foregoing fail to quiet the stomach give 
the following: 

Creosote Compound Tablet, one, 

Water, 6 teaspoonfuls. 

Mix and after the tablet is dissolved give a half-tea- 
spoonful of the mixture every hour as is required to settle 
the stomach. 

The following is also very useful for quieting an irri- 
table stomach in these cases : 

Subnitrate of Bismuth, 1 drachm, 

Beechwood Creosote, 4 drops, 

Muriate of Cocaine, 1 grain, 

Oxalate of Cerium, 8 grains, 

Water, 2 ounces. 

Mix and give a teaspoonful every hour as is required 
to keep the stomach quiet. 



CHOLERA INFANTUM. 269 

Calomel is also an excellent remedy to quiet an irri- 
table stomach. It may be used in the following form: 

Calomel, 1 grain, 

Powd. Ipecac, 1 grain, 

Bicarbonate of Soda, 10 grains. 

Mix and divide into five powders and give one every 
hour until all are taken 

The bowels must be kept empty and for this purpose 
Oil may be administered every day or so as is required. 
Where the Oil cannot be retained enemas will have to be 
used. 

If the fever is of a remittent type the following should 
be used. 

Quinidine, 48 grains, 

Simple Syrup, 1 ounce. 

Mix and give ten drops every. hour and a half during 
the remission. If after having given four doses of it the 
fever still remains down give it every four hours. 

Where the stomach is very irritable 20 grains of the 
Sulphate of Quinine may be mixed with a teaspoonful 
of Vaseline and used every three or four hours by inunc- 
tion instead of the Quinidine. The proper place to apply 
it is under the arms, in the groins, over the stomach and 
bowels and over the spine. 

When the child becomes very weak it will be necess- 
sary to use Digitalis and Cactus, instead of the Aconite, 
and also stimulants such as Aromatic Spirits of Ammonia 
or Whiskey. 



2;o THE PRACTICE OF MEDICINE. 

Thirst may be allayed to some extent, by allowing a 
small lump of ice occasionally, or by tying a small amount 
of pounded ice in a clean cloth and allowing the child to 
suck it. If the ice cannot be obtained a teaspoonful of 
cold water may be given occasionally. The stomach 
may sometimes be caused to retain water by giving the 
child all it cares to drink at one time, and after this is 
thrown off of the stomach then allowing a small 
drink. 

Much of the success in the treatment of cholera in- 
fantum, depends upon the care and judgement used in 
feeding and nursing the patient. 

Milk should compose the principal article of diet, 
adding a tablespoonful of Lime-Water to every four 
tablespoonfuls of milk. Beef-tea, chicken-tea, etc., may 
be allowed. Plenty of fresh air must be admitted into 
the sick chamber. 

Do not change from one remedy to another too often, 
nor use too many remedies at one time. 

The dose here recommended is for a child two years 
old. See Table of Doses. 

CHOLERA. 

Cholera is an acute, specific, infectious disease pre- 
vailing as an epidemic or endemic; characterized by vio- 
lent, persistent purging, and vomiting of a peculiar fluid, 
resembling rice-water; severe muscular cramping, followed 
by prostration, collapse and death; or reaction after 
which a typhoid condition may develop. 



CHOLERA. 271 

It is produced by a specific poison, the coma bacillus 
of Koch. Cholera is but feebly contagious, if contagious 
at all, but is infectious. 

The stools of those suffering with cholera are the prin- 
cipal, if not the only, channel of infection, and it is by a 
contamination of the drinking water with these that the 
disease is mainly propagated. There exists very little, if 
any, danger from being in the presence of those afflicted 
with it, however, the disease may be generated by in- 
haling or swallowing the emanations from the discharges. 

Symptoms: The symptoms vary in different cases; 
in some, an attack is preceded for a few days, by 
diarrhoea; while in others, it commences suddenly with 
chilliness, thirst, slight pain in the abdomen, and purg- 
ing, attended by a decided feeling of weakness. The 
discharges are, at first, feculent and very profuse and are 
voided with considerable force, becoming more frequent, 
and watery as the disease advances, until they finally 
present the characteristic, greyish or whitish, rice-water- 
like appearance. Vomiting of a forcible character makes 
its appearance early in the attack. The vomited matter, 
at first, consists of the ordinary contents of the stomach, 
but afterwards, of the peculiar rice-water-like material 
like that discharged from the bowels. The patient 
becomes prostrated rapidly; thirst is intense, but when 
fluids are taken into the stomach, they almost immediately 
excite vomiting. 

Cramping of the muscles of all parts of the body, but 
more severe in the calves of the legs, is usually present 



272 THE PRACTICE OF MEDICINE. 

and is almost unbearable. Breathing becomes difficult; 
the skin assumes a purplish hue; the eyes are sunken, 
and surrounded by dark rings; the nose is pointed; the 
cheeks are hollow; and the urine scanty or suppressed. 

As the disease advances the temperature declines 
rapidly; the skin becomes cold and clammy; the pulse 
small and weak, sometimes imperceptible at the wrists; 
the tongue and breath are cold, the mind usually 
remaining clear to the last; however, the patient is indif- 
ferent to his danger. This is commonly designated the. 
stage of collapse. It either terminates in death in from 
three to forty-eight hours, or in reaction. 

When it terminates by the latter method, the tem- 
perature gradually rises; the pulse increases in strength; 
the countenance becomes more .natural ; breathing becomes 
free and easy; the vomiting and purging become less 
frequent and feculent; the flow of urine is increased 
and the patient slowly recovers; or a typhoid condition 
develops, which greatly retards recovery and may end 
in death. One peculiarity about the disease is, that the 
temperature usually rises after death, the body remaining 
warm for a considerable time. 

An attack of cholera is not infrequently followed by 
a diphtheritic inflammation of the mucous membranes, 
abscesses in various parts of the body, more especially 
of the parotid glands, bronchitis, pneumonia, pleurisy, 
erysipelas, etc. Indiscretions in diet may cause a relapse. 
One attack does not render the patient immune from 
subsequent attacks. 



CHOLERA. 273 

Treatment: During the presence of cholera in a 
community the slightest diarrhoea should receive prompt 
treatment. The following, in these cases, is very efficient: 

Subnitrate of Bismuth, 1 \ drachms, 

Fl. Ext. of Bay Berry, \ ounce, 

Paregoric, sufficient to make, 2 ounces. 

Mix and give a teaspoonful every two or three hours 
until relieved. 

In an attack of cholera, as soon as the nature of the 
case is discovered, put the patient to bed; require him 
to remain perfectly quiet; do not allow him to assume the 
sitting posture at all; use a bed-pan or old cloths when 
there is a discharge from- the bowels, and administer at 
once, hypodermically, \ of a grain of the Sulphate of 
Morphine. Should no relief follow in twenty or thirty 
minutes, the dose must be repeated, closely watching its 
effects. A J of a grain of Morphine should be admin- 
istered hypodermically every four or six hours, as it is 
required, throughout the attack. 

Cloths wrung out of hot water should be applied to 
the abdomen and changed sufficiently often to prevent 
their becoming cool. 

Vomiting and thirst may usually be alleviated to 
some extent by allowing a small lump of ice occasionally. 
Should this fail to control the vomiting, \ of a grain of 
the Hydrochlorate of Cocaine should be given every hour 
or so. 

The cramping of the muscles may be relieved to some 
extent by rubbing the parts briskly and by the applica- 



274 THE PRACTICE OF MEDICINE. 

tions of heat, such as hot rocks, bricks or irons, to the 
parts, or by inhalations of Chloroform or Ether. 

When the stage of collapse occurs, wrap the patient 
well with a blanket wrung out of hot Mustard-Water, 
then, apply hot rocks, bricks, irons, etc., and admin- 
ister 1-20 of a grain of the Sulphate of Strychnine, hypo- 
dermically, every three or four hours. The hypodermic 
use of Whiskey, in large doses, is also very beneficial in 
these cases. 

Should reaction occur and convalescence be estab- 
lished without complications, the following may be given: 

Fl. Ext. of Nux Vomica, 2 drachms, 

Fl. Ext. of Hydrastis Can., 5 drachms, 

Fowler's Solution of Arsenic, 1 drachm, 

Aromatic Elixir, sufficient to make, . . 4 ounces. 

Mix and give a teaspoonful before each regular meal. 

Where an attack is followed by a typhoid condition, 
or other complications, the case must be treated on gen- 
eral principles. 

During convalescence the patient must remain quiet 
in bed; and water and food very sparingly allowed and, 
the latter, selected with the greatest care and judgement. 

The stools, urine and vomited matter should be dis- 
infected by pouring boiling water upon them, and then, 
buried. 

During the prevalence of cholera, in a community, 
no one should eat any food, fruit, or vegetables that -have 
not been thoroughly cooked and drink no liquids that 
have not recently been boiled. 



CATARRHAL ENTERITIS. 275 

CATARRHAL ENTERITIS; MUCO-ENTERITIS. 

INFLAMMATION OF THE SMALL INTESTINES. 

This is an acute inflammation of the mucous mem- 
brane of a whole or any part of the small intestines; char- 
acterized by pain and tenderness in the region of 
the umbilicus, fever, and looseness of the bowels, the 
discharges containing more or less mucus and in some 
cases shreds. It may be either acute or chronic. 

The great majority of cases occur between the first 
of May and the last of September; therefore, we conclude 
that, warm weather is one of its most important causes; 
and, when we add to this atmospheric changes, improper 
food and unhygienic surroundings the list of causes is 
probably complete. Children between the ages of six 
and eighteen months are much more subject to it than 
others. 

A remarkable number of bacteria have been isolated 
from the stools. Booker claims to have discriminated 
forty varieties. It should be borne in mind that organ- 
isms are also found in healthy stools. 

Symptoms: An attack usually commences with more 
or less pain and tenderness in the region of the umbilicus 
followed by diarrhoea and fever, the temperature ranging 
from 102 to 103 , sometimes higher. The discharges 
at the beginning of the attack are usually not very fre- 
quent, but are attended by more or less pain and strain- 
ing. The character of the stools varies in different cases; 
in nursing children, they at first, consist of a greenish 
material mixed with curdled milk; in other cases, they 



2?6 THE PRACTICE OF MEDICINE. 

are greenish or dark-colored, sometimes frothy. As the 
disease progresses more or less mucus, and, in some cases, 
shreds of mucous membrane, and, rarely, blood appear 
in the discharges, which are accompanied by increased 
pain and straining. The bowels are usually flat and 
shrunken, but in protracted cases may become swollen and 
tympanitic from an accumulation of gas. The tongue 
is usually furred with a whitish coat, its tip and edges 
being red, and nausea and vomiting are not uncommon. 

The fever is of a remittent type, but if the disease is 
severe or protracted, it assumes a continued or typhoid 
type, when, the tongue becomes dark or purplish and 
sordes appear on the lips and teeth. 

The average duration of an attack, is from four to 
fifteen days. 

The disease is frequently mistaken for diarrhoea 
caused by irritation, and dysentery, but no particular 
harm results from this mistake as the treatment for the 
three diseases is almost identical. 

Treatment: This should be commenced by the 
administration of a full dose of Oil or Salts for the pur- 
pose of thoroughly emptying the bowels; and the use of 
these remedies every two or three days during the attack 
should not be neglected. After the effects of the Oil or 
Salts have been obtained give the following: 

Subnitrate of Bismuth, 40 grains, 

Sulpho-carbolate of Zinc, 2 grains. 

Mix, divide into eight powders and give one of them 
every three hours. 



CATARRHAL ENTERITIS. 2^ 

Control the fever with Aconite adding Ipecac, as follows: 

Tr. of Aconite Root, 8 drops, 

Fl. Ext. of Ipecac, 8 drops, 

Water, 8 teaspoonfuls. 

Mix and give a half-teaspoonful every hour and a 
half or two hours while there is fever. If the face is 
flushed, the eyes bright and the pupils contracted add 
J of a drop of the Fl. Ext. of Gelsemium to each dose 
of the Aconite; or if the patient sleeps more than natural, 
the pupils being too large, instead of the Gelsemium add 
I of a drop of the Fl. Ext. of Belladonna to each dose of 
the Aconite. 

Where the fever is high and the pupils not larger than 
natural, a \ of a grain of Acetanilide should be given every 
three or four hours. 

Add a tablespoonful of the Spirits of Turpentine to 
a quart of warm water and apply clothes, wrung out of 
it to the bowels, changing them frequently to prevent 
their becoming cool. If preferred, instead of the cloths, 
just mentioned, warm poultices may be used, however, 
the cloths usually answer a better purpose. 

Nausea and vomiting, when present, may usually be 
relieved by the following: 

Creosote Compound Tablets, one, 

Water, 6 teaspoonfuls. 

Mix and when the tablet is dissolved give a half- 
teaspoonful every hour until relief is obtained. At the 
same time a Mustard-Plaster should be applied over the 
region of the stomach. 



278 THE PRACTICE OF MEDICINE. 

Where the tongue is broad, pallid and coated with 
a dirty, whitish, pasty material, give 2 grains of the Sul- 
phite of Soda every four hours; or if the tongue is too red, 
or red and dry, give \ of a drop of Hydrochloric Acid, 
well diluted with water, every three or four hours. 

If the tongue becomes dark or purplish Echinacea 
or Baptisia should be given. They may be added to the 
Aconite. 

Where the fever is periodic Quinidine should be given 
during the intermission or remission. It may be prepared 
for use as follows: 

Quinidine, 20 grains, 

Simple Syrup, 1 ounce. 

Mix and give 8 drops every hour and a half while 
there is no fever. If after having given four doses in this 
manner fever does not appear it should then be given 
not oftener than every three or four hours. Quinidine 
is a very important remedy in these cases, especially 
where there is a malarial complication. Where it cannot 
be obtained the Sulphate of Quinine may be used in its 
stead. 

Where the fever assumes a continued or typhoid type 
treat it as such; and if diarrhoea continues after the in- 
flammation has subsided, treat it as you would any other 
diarrhoea. 

From the commencement of the attack keep the 
patient as quiet as possible and restrict the diet to such 
articles as milk and Lime- Water, weak mutton or chicken- 
soups with well-boiled rice added. 



CHRONIC ENTERITIS. 279 

The dose given in this article is for a child one year 
old. See Table of Doses. 

CHRONIC ENTERITIS. 

CHRONIC DIARRHCEA. 

This is a chronic inflammation of the mucous mem- 
brane of the small intestines, commonly known as chronic 
diarrhoea; characterized by fluid or semi-fluid stools, 
tenderness in the region of the umbilicus, loss of appe- 
tite, impairment of digestion, emaciation and sometimes a. 
marked remittent fever, followed in the latter stages of 
the disease by hectic fever and night-sweats. 

It may be the result of an acute attack of the disease, 
or it may be developed during the continuation of an 
ordinary diarrhoea, but the most common causes of it are 
the long use of improper food and exposure to excessive 
heat, especially of persons who have been accustomed 
to a cold climate. 

Symptoms: In chronic diarrhoea the patient has a 
variable number, sometimes ten or fifteen, again only two 
or three fluid or semi-fluid evacuations from the bowels 
during each twenty-four hours. The color of the dis- 
charges is variable, sometimes they are of a light clay- 
color or yellowish, at others dark or greenish, often con- 
taining mucus, shreds of mucous membrane and some- 
times blood. 

The appetite is more or less impaired, digestion en- 
feebled, the patient becoming greatly debilitated ; and does 
not sleep well during the night. There is more or less 



280 THE PRACTICE OP MEDICINE. 

tenderness felt when firm pressure is made over the region 
of the abdomen. 

Nervousness, with occasional pains in the head is quite 
common, and there is, in some cases, a well-marked type 
of remittent fever, which, in the latter stage of the disease, 
is sometimes followed by hectic fever and night-sweats. 
Treatment: This should be commenced by the 
administration of the following: 

Subnitrate of Bismuth, 3 drachms, 

Fl. Ext. of Myrica Cerifera , 1 ounce, 

Paregoric, sufficient to make, 4 ounces. 

Mix and give a teaspoonful every three or four hours 
as is required. 

There are a variety of astringents that may be used in 
these cases, the most important of which are the following: 
Tannin in from 5 to 20-grain doses four or five times 
a day; Nitrate of Silver in from \ to J-grain doses three 
times a day; Sulphate of Copper in from \ to 1 -grain 
doses three or four times a day; Acetate of Lead in from 
1 to 3-grain doses and the Subnitrate of Bismuth in from 
30 to 40-grain doses four or five times a day. 

The daily irrigation of the bowels with one of the fol- 
lowing solutions is of the utmost importance: 

Salicylic Acid, 160 grains, 

Water, 1 quart. 

Mix and use at once, or: 

Boracic Acid, 5 drachms, 

Water, 1 quart. 

Mix and use at once, or: 



TYPHILITIS. 281 

Tannin, 160 grains, 

Water, 1 quart. 

Mix and use at once, or: 

Nitrate of Silver, „ 8 grains, 

Water, 1 quart. 

Mix and use at once. 

All of the foregoing should be used warm. No ap- 
pliance is needed except a fountain syringe with a soft 
rubber end-piece, which should be inserted well up into 
the bowel when, the fluid may be allowed to slowly flow. 
The patient should, as a rule, be placed in the knee- 
chest position in order to let the fluid be carried as high 
as possible. 

Patients suffering with chronic diarrhoea should wear 
flannel next to the skin the entire year; avoid all exposure 
and intemperance. No definite rules in regard to diet 
can be given. Many patients do well on an exclusive 
milk-diet, while others do well on scraped beef, raw or 
underdone. In a majority of cases toast, tender beef or 
mutton, oysters, raw or boiled eggs, thoroughly cooked 
rice, arrow-root and plain custard may be allowed. 

Foods that are bulky and leave much residue must 
be prohibited. 

TYPHILITIS. 

INFLAMMATION OF THE (LECUM. 

Typhilitis is an inflammation of the mucous mem- 
brane of the caecum and ascending colon; characterized 
by fever, pain, tenderness, and, in some cases, vomiting 
of a material that has the odor of faeces. 



282 THE PRACTICE OF MEDICINE. 

Its most common cause is the presence of foreign 
bodies or the impaction of faeces within the caecum. 

Symptoms: An attack usually commences with pain 
and tenderness with more or less fullness in the right iliac 
region and ascending colon. The bowels soon become 
distended with gas and are obstinately constipated, how- 
ever, in some cases there may be small liquid stools. 

From one to three degrees of fever is present in all 
cases; and there are naus.ea and vomiting; first, of the 
contents of the stomach, then, of the duodenum with 
bilious matter; and, if relief is not obtained, ultimately 
of a material having the odor of faeces. 

With these last-named symptoms there is great de- 
pression of the vital powers; and, finally, by contiguity 
of tissue or by rupture of the bowel, peritonitis is devel- 
oped and death soon closes the scene. 

In other cases the bowels move freely and the 
patient is soon convalescent. 

The usual duration of an attack is from one to two 
weeks. 

Treatment: Put the patient to bed and require him 
to remain quiet; apply hot poultices over the painful 
region, changing them frequently in order to prevent 
their becoming cool. 

Control fever, when present, with sedatives admin- 
istered according to indications. 

Administer a full dose of Salts every four or five 
hours until free actions from the bowels are obtained. 



APPENDICITIS. 283 

Should the Salts fail to act on the bowels promptly, 
copious injections of warm soap-suds should be fre- 
quently used. 

If the pain is very severe, and the hot poultices do 
not relieve it, J of a grain of the Sulphate of Morphine 
may be given, hypodermically, every four or five hours 
as is necessary, however, use no more Morphine than is 
absolutely necessary to make the patient's condition 
bearable. 

If the vomited matter has the odor of faeces or if the 
symptoms of peritonitis develop, call a competent sur- 
geon at once. 

APPENDICITIS. 

PERITYPHLITIS J PERITYPHLITIC ABSCESS. 

Appendicitis is an acute or subacute inflammation 
of the appendix vermiformis, involving the surrounding 
tissues (with a localized peritonitis) leading to perforation 
of the appendix and the development of an abscess. 

Perityphlitis is "an acute inflammation of the connec- 
tive tissue around the caecum (with localized peritonitis) 
leading to the formation of an abscess." 

" Appendicitis usually results from the presence of a 
foreign body in its canal, consisting of inspissated faecal 
masses, which becoming incrusted with lime salts, are 
termed faecal calculi; and becoming rounded in shape 
closely resemble a cherry-stone, for which they have been 
mistaken. Foreign bodies, particularly seeds of fruit, 
sometimes, but not so often as is believed, by the laity, 
gain access to the appendix and produce inflammation 



284 THE PRACTICE OF MEDICINE. 

leading to perforation. Torsion of the appendix is also 
among the infrequent causes. The disease is more com- 
mon in males than females. Occurs most frequently 
between the ages of ten years and thirty years. Relapses 
are rarely frequent in cases not progressing to perfor- 
ation." 

"The great majority of cases of perityphlitis are sec- 
ondary to inflammation of or perforation of the vermi- 
form appendix — appendicitis. Have seen two cases of 
true perityphlitis, the result of exposure to cold and 
wet." 

Symptoms: "The symptoms of the two conditions 
are much alike; begins with a feeling of weight, soreness 
and rapidly developing and severe pain in the lower right 
abdomen, accompanied with nausea and vomiting. The 
pain is increased by lying on the left side, the right leg 
is drawn, the abdomen becomes tense, prominent and 
tender, with the progressive development of a hard 
swelling in the right iliac region. The temperature at the 
onset is from 99 to ioo°, and may or may not be preceded 
by a chill; the pulse 80, full and strong, the tongue 
coated with red tips, the bowels costive. In addition 
to the persistent, localized pain, occurs severe colicky 
paroxysms, which may shoot into the hip and thigh. The 
expression of the patient is pinched and suffering. The 
special tendency of the disease is towards suppuration, 
which is announced by irregular chills, feverishness, the 
temperature shooting suddenly to ioi°-io3°, and sweats, 
and a feeling of tension and throbbing. Its develop- 



DYSENTERY. 285 

ment is slow, and if associated with typhlitis the symp- 
toms of that affection are added." 

Complications : " Perforation of the appendix. Local 
or general peritonitis." 

"Diagnosis: Differs from typhlitis by the absence 
of colicky pains, dyspeptic symptoms, costive bowels 
and tympanites preceding the development of a tumor; 
in perityphlitis the tumor is present with the develop- 
ment of the symptoms." 

"Psoas abscess is not associated with intestinal symp- 
toms, and the discharge is free from a faecal odor. Renal 
and ovarian tumors should not be sources of error. The 
possibility of a hernal tumor must not be overlooked." 
— Hughes. 

Treatment: Put the patient to bed and require 
him to remain quiet, administer a full dose of Salts and 
apply poultices, as hot as can be borne, over the painful 
region. Should these means fail to give relief, call a com- 
petent surgeon at once. 

DYSENTERY. 

FLUX. 

Dysentery is an inflammation of the mucous mem- 
brane of the colon, sometimes extending to the rectum 
(Proctitis); characterized by fever, griping pains in the 
bowels and tenesmus attended by frequent, small dis- 
charges of mucus, and sometimes shreds of mucous mem- 
brane, mixed with more or less blood and, in some cases 
pus. 



286 . THE PRACTICE OF MEDICINE. 

Four forms of the disease are recognized; acute 
catarrhal, croupous or diphtheritic, chronic, amoebic or trop- 
ical. We shall make no distinction in its several forms 
in this article as it would be confusing to the minds of 
our readers, besides it would be of no practical benefit, 
the treatment of all forms of the disease being virtually 
the same. All forms of the disease prevail in North 
America and may occur either sporadically, endemically 
or epidemically. 

Its most common causes are sudden atmospheric 
changes, improper food, bad hygienic surroundings and 
excessive physical exertion during warm damp weather. 
The amoebic form of the disease is caused by the amoeba 
coli or the amoeba dysenteria. Their mode of entering 
the system is not definitely known, however, the prin- 
cipal source is probably the drinking-water. Amoebic 
dysentery is not contagious but infectious. 

Symptoms: In many cases an attack is preceded 
two or three days by diarrhoea; in others, it commences 
with a chill or a sense of chilliness, which is followed by 
fever, an accelerated pulse, more or less pain and uneasi- 
ness in the bowels and the appearance of the character- 
istic stools. For the first day or two the discharges 
contain more or less faecal matter but they soon change to 
mucus mixed with blood and sometimes pus. There 
are colicky pains in the region of the umbilicus; pain on 
pressure over the transverse and descending colon; a 
burning pain in the lower part of the rectum with an 
almost constant desire to go to stool; and when the bowels 



DYSENTERY. 287 

act there is straining with a feeling as if more should pass. 
The stools are sometimes very numerous, amounting to 
as many as fifty, or even a hundred, during twenty-four 
hours. The urine is scanty and ' high-colored. Per- 
sistent nausea and vomiting are not uncommon. 

The fever at the beginning of the attack is usually of 
a remittent type, but as the disease advances it frequently 
assumes a continued or typhoid type; the pulse becomes 
weak and quick or irregular, the tongue red and dry or 
rather a dark brown, and sordes appear on the lips and 
teeth. 

In some cases the discharges from the bowels resemble 
prune-juice; while in others, they contain pus, patches of 
membrane and even casts of the bowel with more or less 
gangrenous mucous membrane of a very offensive odor. 
Prostration in these cases is great; the expression anxious 
and emaciation extreme. 

Where relief is not obtained the patient grows weaker 
day by day and death soon closes the scene. 

The duration of an attack is from a few days to weeks. 

The disease may be complicated with abscess of the 
liver or lungs, intestinal perforation, peritonitis and in- 
flammation of the intestinal veins. 

Treatment: Put the patient to bed and require 
him to remain quiet; administer a full dose of Salts and 
as soon as it has acted on the bowels give the following: 

Subnitrate of Bismuth, 2 drachms, 

Fl. Ext. of Myrica Cerifera, J ounce, 

Paregoric, sufficient to make, 2 ounces. 



288 THE PRACTICE OF MEDICINE. 

Mix and give a teaspoonful every two or three 
hours, or: 

Subnitrate of Bismuth, 2 drachms, 

Sulpho-carbolate of Zinc, 36 grains, 

Dover's Powder, 48 grains. 

Mix, divide into twelve powders and give one of them 
every three hours. If relief is not obtained, within thirty- 
six or forty-eight hours, another dose of Salts should be 
given, and the other treatment continued as before. In 
many cases, especially mild ones, this is all that is required. 
If the patient has fever, in addition to what has 
already been recommended give the following: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Ipecac, 18 drops, 

Water, 18 teaspoonfuls. 

Mix, and give a teaspoonful every hour and a half 
while there is fever. Of course, if there is flushed face 
with bright eyes and contracted pupils, Gelsemium should 
be added to the Aconite; or if the patient is sleeping more 
than natural, the eyes remaining partly open, the pupils 
being too large, Belladonna should be added instead of 
the Gelsemium. 

Throughout the attack a sufficient amount of some 
form of Opium should be given to control the peristaltic 
action of the intestines. When the prescriptions contain- 
ing the Paregoric or Dover's Powder are used no Opium 
should be given, as these remedies contain a sufficient 
amount of the drug to accomplish this. Where no other 
form of Opium is being used 6 or 8 drops of Laudanum 



DYSENTERY. 289 

(Tr. of Opium) may be given every four or five hours. 
Where there is severe tormina it may be given every hour 
until the pain is relieved, however, care must be exercised 
not to introduce a sufficient quantity of it into the system, 
at one time, to act as a poison. 

Pain may be controlled to a great extent by hot 
applications, such as hot poultices or cloths wrung out of 
hot Turpentine-water, to the bowels. If these applica- 
tions are used they must be changed sufficiently often 
to prevent their becoming cool. 

Where there is severe tenesmus the following usually 
affords marked relief: 

Laudanum, 30 drops, 

Starch, 1 teaspoonful, 

W T ater, 4 ounces. 

Mix and inject into the rectum requiring the patient 
to retain it as long as possible. 

Should nausea and vomiting occur apply a Mustard- 
Plaster over the region of the stomach and give a Creo- 
sote Compound Tablet every hour. See Irritation of 
the Stomach. 

If the fever is of a remittent type give Quinine during 
the remission as is recommended for remittent fever. If 
the patient is a child, Quinidine combined with Simple 
Syrup should be used instead of the Quinine. 

If the fever assumes a typhoid type treat it as such. 
See Typhoid Fever. 

Where there is ulceration of the bowels Iodoform 
should be added to the Bismuth, thus: 



290 THE PRACTICE OF MEDICINE. 

Subnitrate of Bismuth, 2 drachms, 

Iodoform, 12 grains. 

Mix, divide into twelve powders and give one every 
four hours; and, at the same time, use the following: 

Tannin, 160 grains, 

Water, 1 quart. 

Mix and inject into the rectum two or three times 
a day, or: 

Boracic Acid, 5 drams, 

Water, 1 quart. 

Mix and use in the same manner, or: 

Nitrate of Silver, 8 grains, 

Water, 1 quart. 

Mix and use in the same manner. 
Should these injections produce severe pain a small 
amount of a 4 per cent, solution of Cocaine may be 
injected into the rectum before using them. 

Where the disease assumes a chronic form treat it 
precisely as you would Chronic Enteritis, which see. 

The diet should consist of such articles as milk, 
chicken-soup, beef-soup, mutton-soup and soft poached 
eggs. 

PROCTITIS. 

INFLAMMATION OF THE RECTUM. 

Proctitis is an inflammation of the mucous membrane 
of the rectum and anus; characterized by burning pain, 
tenesmus, and frequent discharges of hardened faeces, 
or mucus, pus and blood. 



PROCTITIS 291 

The most common causes of it are constipation; 
the presence of foreign bodies; sitting on cold, damp 
ground or stone; the continued use of such purgatives 
as Aloes; the frequent use of stimulating enemas; dis- 
eases of the liver, and hemorrhoids. 

Symptoms: It usually commences with tenesmus, a 
feeling of fullness and burning pains that extend from 
the region of the anus into the loins and back. There 
are frequent discharges of hardened faeces, sometimes 
mucus, blood and pus. These discharges are not infre- 
quently attended by prolapsus of the rectum and diffi- 
culty in passing the urine, and in some cases stran- 
gury. 

Feverishness with headache and loss of appetite are 
usually present; and, if the case is protracted or severe, 
there is liable to be an inflammation of the connective 
tissue surrounding the rectum, known as periproctitis, 
which usually terminates in the formation of pus and 
fistulous openings. 

The disease sometimes terminates in a chronic form 
instead of the periproctitis. 

The average duration of an attack is from five to ten 
days. 

Treatment: Put the patient to bed and require 
him to remain quiet; and in order to liquify the stools give 
a full dose of Salts every three or four hours until the 
desired effect is obtained. If there are hardened faeces in 
the rectum, injections of large quantities of warm soap- 
suds should be frequently used until these are removed. 



292 THE PRACTICE OF MEDICINE. 

Warm poultices may be applied over the perinaeum 
and lower part of the bowels; and, if the pain is very 
severe a \ of a grain of the Sulphate of Morphine may be 
given every four or five hours, preferably hypodermically. 

In many cases, especially where the inflammation is 
not too far advanced, the disease subsides as soon as free 
actions are obtained from the bowels. Should conval- 
escence not be established at this stage, or the disease 
assume a chronic form, remedies will have to be used 
locally by means of injections; and the following answers 
a good purpose in these cases: 

Tannin, 20 grains, 

Laudanum, 30 drops, 

Carbolic Acid, 10 drops, 

Starch, 1 teaspoonful, 

Water, 4 ounces. 

Mix and inject into the rectum at once. This should 
be repeated three or four times a day. The patient 
should be instructed to retain the material injected as long 
as possible. 

If the patient has fever control it with sedatives 
administered according to indications as in any other 
disease. 

If there is prolapsus of the rectum, replace it at once. 
This may be accomplished by applying an old, soft cloth, 
well anointed with Vaseline or common lard over the 
protruded part and making gentle, but firm, pressure with 
the finger-tips and thumb until the intestine is returned 
to its proper place. 



HEMORRHOIDS. 293 

Should the disease result in periproctitis and the for- 
mation of an abscess, the pus must be evacuated early 
by a free incision. A competent surgeon should be called 
to attend to this. If the patient is very weak it may be 
necessary to give stimulants; and where he is debilitated, 
the following tonic should be given: 

Fl. Ext. of Nux Vomica, 2 drachms, 

Fl. Ext. of Hydrastis Can., 5 drachms, 

Aromatic Elixir, sufficient to make,. .4 ounces. 
Mix and give a teaspoonful before each regular 
meal. 

The diet should be the same as that recommended 
in dysentery 

HEMORRHOIDS. 

PILES. 

Haemorrhoids, or piles, are tumors formed in the rec- 
tum or at the verge of the anus by an enlargement of the 
haemorrhoidal blood vessels; characterized by pain, sore- 
ness and fullness in the rectum and more or less haemor- 
rhage in the internal variety. 

There are two forms of haemorrhoids; internal and 
external. 

The condition may be caused by anything that in- 
terferes with the return of blood from the rectum, such 
as impacted faeces, habitual constipation, pregnancy, 
pelvic tumors, cirrhosis of the liver, valvular disease of 
the heart, etc. Sedentary habits and luxurious living 
are predisposing causes. It is thought that some persons 
possess a hereditary tendency to them. 



294 THE PRACTICE OF MEDICINE. 

Symptoms: "The symptoms of haemorrhoids vary 
with the size, number, stage and seat of the tumors. At 
first there is a feeling of weight and fullness in the rectum, 
or a sensation as if a foreign body were present. During 
and after a hard stool, there is a throbbing, aching, or 
burning pain, radiating to the loins or down the limbs. 
There is heat, soreness and tingling about the anus, and 
as the tumor increases in size, sitting becomes uncom- 
fortable, and the individual grows restless, depressed, and 
anxious. The pain soon becomes constant and is always 
more severe after a passage or after a moderate walk." 
"Internal haemorrhoids have as their chief symptom, 
bleeding, when the bowels are evacuated. From this 
symptom the name is derived. Slight internal piles may 
exist for years and only produce local itching and heat. 
Large internal piles are almost always protruded during 
a passage, but at first they are easily replaced. Later 
on, standing or walking may cause them to protrude. 
When they are congested, and protrude, they appear as 
dark, purple, soft, vascular tumors. The amount of 
blood lost in internal haemorrhoids varies from two 
drachms to a quart. In the latter case there is marked 
exhaustion and anaemia." — Loomis. 

Treatment: Prohibit the use of cathartic medicines 
and if the bowels are constipated, administer the following: 

Fl. Ext. of Nux Vomica, 2\ drachms, 

Fl. Ext. of Belladonna, 48 drops, 

Fl. Ext. of Cascara Sagrada, 2 ounces, 

Aromatic Elixir, sufficient to make, .... 6 ounces. 



HEMORRHOIDS. 295 

Mix and give a teaspoonful before each regular meal. 
If it produces more than two actions from the bowels, 
during each twenty-four hours, decrease the dose. 

The following will sometimes afford marked relief: 

Fl. Ext. of Witch Hazel, 4 drachms, 

Warm Water, sufficient to make, 4 ounces. 

Mix and inject into the rectum after each action from 
the bowels, or: 

Tannin, 80 grains, 

Warm Water, 4 ounces. 

Mix and use as the preceding prescription. 
When the tumors are inflamed, bathe them frequently 
with cold water, or apply hot poultices to them and also 
use the following: 

Extract of Belladonna, 1 drachm, 

Extract of Stramonium, 1 drachm, 

Sugar of Lead, 10 grains, 

Vaseline, 1 ounce. 

Mix and apply directly to the tumors every three or 
four hours, or: 

Extract of Belladonna, 1 drachm, 

Extract of Stramonium, 1 drachm, 

Tannin, , 20 grains, 

Iodoform, 1 drachm, 

Vaseline, 1 ounce. 

Mix and apply to the parts every four hours, or: 

Extract of Belladonna, 1 drachm, 

Extract of Stramonium, 1 drachm, 

Iodoform, 1 drachm, 



296 THE PRACTICE OF MEDICINE. 

Hydrochlorate of Cocaine, 20 grains, 

Sulphate of Morphine, 10 grains, 

Vaseline, 1 ounce. 

Mix and apply to the parts every four or five hours. 
Where the tumors are very sensitive and painful this 
last prescription will be found to be more satisfactory 
than the preceding ones. 

There . are various methods of treating haemorrhoids 
with a view of making a permanent cure, but as the 
unprofessional could not use any of them, the subject is 
dismissed without further comment and the reader, for 
further treatment, is referred to a competent surgeon. 

ANAL FISSURE. 

FISSURE OF THE ANUS. 

This is a small fissure, or crack in the mucous mem- 
brane near the verge of the anus, resembling the fissure 
seen in working men's hands during cold weather; char- 
acterized by burning, aching, throbbing pain when at 
stool and finally violent contraction of the sphincter 
muscles of the part and debility. 

Symptoms: The first symptom that attracts atten- 
tion is burning or smarting at some particular part of the 
anus, especially when at stool. As the disease advances, 
the pain becomes more severe and is aching and throb- 
bing in character. Finally there are violent contractions 
of the sphincter muscles of the part during, and for some 
time after, a stool. The discharges, on account of these 
contractions, are ribbon-shaped. They are also fre- 
quently streaked with blood, pus and mucus. Finally 



ANAL FISSURE. 297 

the pain becomes almost unbearable, when, the patient 
is usually greatly debilitated. 

Treatment: Local applications, without an oper- 
ation, in the treatment of anal fissure, are worthless. 

Several operations are recommended, the most simple 
of which is the forcible dilatation of the sphincter mus- 
cle. This may be accomplished by introducing both 
thumbs into the anus, then, bending them at right angles 
and quickly and forcibly withdrawing them while thus 
bent. 

This accomplished, the following ointment should 
be used: 

Iodoform, 1 drachm, 

Vaseline, 1 ounce. 

Mix and apply to the part three times a day. The 
patient should remain in bed until the soreness sub- 
sides. 

Previous to the operation the bowels should be reg- 
ulated with Cascara Sagrada and its use should be con- 
tinued until the patient has fully recovered. 

The diet should be light, consisting of soups, milk, 
teas, etc. 

Where patients are greatly debilitated the following 
tonic should be given: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make, . . 6 ounces. 
Mix and give a teaspoonful before each regular meal. 



298 THE PRACTICE OF MEDICINE. 

PROLAPSUS ANI. 

PROTRUSION OF THE RECTUM. 

Prolapsus ani, or protrusion of the rectum, is a par- 
tial descent of the bowel without the anus. The size of 
the protruded bowel varies from the mere appearance 
of the intestine at the anus to that of a hen's egg or even 
larger. 

The most common causes of it are relaxation of the 
parts, constipation, diarrhoea, haemorrhoids and straining 
when at stool. It may occur at any age, but children 
and elderly persons are more subject to it than others. 

Treatment: The bowel should be returned to its 
proper place at once. This may be accomplished by 
anointing an old, soft cloth with Vaseline, or common 
lard and applying it over the anus, then, making firm but 
gentle pressure with the finger-tips and thumbs. The 
performance may be greatly facilitated by placing the 
patient on the knees with the head resting on a pillow. 

After the bowel is replaced, a pad and a"T" bandage 
should be applied in order to retain it in place. 

The injection of equal parts of the Fl. Ext. of Pinus 
Canadensis and water two or three times a day is very 
beneficial in these cases. The following is also useful 

Tannin, 80 grains, 

Water, 4 ounces. 

Mix and inject into the bowel three times a day. 

The action of the bowels must be carefully regulated 
and the patient instructed to avoid straining when at 
stool. 



FISTULA IN ANQ 299 

The diet should be nutritious and easily digested. 
FISTULA IN ANO. 

FISTULA OF THE ANUS. 

Fistula in ano is an unnatural pipe or canal, in the 
region of the anus, in which there is no disposition to 
heal. When the opening leads from the external parts 
into the bowel, it is said to be a complete fistula; when 
the opening or pipe does not communicate with the 
intestine, it is said to be an external, incomplete or blind 
fistula; and when the opening is in the bowel and not 
communicating with the external parts, it is said to be an 
internal, incomplete, or blind fistula. 

The usual causes of it, are some form of mechanical 
pressure, or an impediment to the free discharge of the 
faeces. It may follow an attack of periproctitis. Scrof- 
ulous or tuberculous persons are more subject to it than 
others, and men are more subject to it than women. 

Symptoms: The disease usually makes it appearance 
with an ordinary abscess in the region of the anus. This 
is sometimes accompanied by high fever, quickened pulse, 
thirst, etc. 

In some cases the pain and swelling are very slight, 
so much so that very little attention is attracted to it un- 
til the discharge of pus occurs, which may be from only 
one opening or from several. One important point in 
the diagnosis of fistula is that the discharge has the odor 
of faeces. 

After the opening or openings are once established 
they show no disposition to heal without surgical aid. 



3 oo THE PRACTICE OF MEDICINE. 

The disease within itself is not dangerous to life, but 
it is not infrequently associated with a constitutional dis- 
ease that may terminate in death. 

Treatment: Every abscess in the region of the anus 
should be looked upon with suspicion and receive prompt 
treatment. They should be freely incised and their cav- 
ities thoroughly cleansed with Peroxide of Hydrogen, 
after which, a Solution of Carbolic Acid or Tr. of Iodine 
should be injected into them. 

There are a variety of plans recommended for the rad- 
ical cure of fistula, the most reliable of which is the free 
use of the surgeon's knife. 

HERNIA. 

RUPTURE. 

Hernia is a protrusion of some organ from the cavity 
where it belongs, as the brain, lungs, etc., but it is gen- 
erally understood to be a protrusion of an intestine from 
the cavity of the abdomen, and it is in this sense that the 
word is here used. 

Hernia is said to be reducible when the protruding 
intestine can be returned into the cavity of the abdomen 
by manipulation; and it is said to be irriducible when it 
cannot be returned, on account of adhesions, by this 
method. 

Hernia is said to be strangulated when there is a con- 
striction at some point — usually the place of exit — which 
interferes with the circulation of blood and the passage 
of the contents of the bowels through the protruded 
knuckle of intestine. A partial illustration of the con- 



HERNIA. 301 

dition that results under such circumstances may be seen 
by tying a cord rather tightly around a finger and allow- 
ing it to remain for some time. 

The principal varieties of hernia are inguinal, fem- 
oral, and umbilical. 

In inguinal hernia the intestine protrudes through 
what is known as the inguinal canal. This canal is about 
an inch and a half in length, extending from the internal 
abdominal ring above, downward, inward, and forward, 
to the external abdominal ring. In the male it trans- 
mits the spermatic cord and in the female the round liga- 
ment. In this form of hernia the intestine usually descends 
into the scrotum in the male and into the labium in the 
female. 

In femoral . hernia the intestine passes out of the 
abdominal cavity through the crural ring beneath 
Poupart's ligament. This form of hernia is more common 
in women than in men. 

In umbilical hernia the intestine passes out of the 
abdominal cavity through the umbilical ring, and is usu- 
ally present at birth, though, it may make its appearance 
later in life. 

Hernia may be caused by violent crying, sneezing, or 
coughing, especially in children before a proper contrac- 
tion of the abdominal walls have occurred around the 
remains of the umbilical cord. Anything that occasions 
general or local muscular debility may be the predispos- 
ing cause, such as dropsy, pregnancy, etc. The tendency 
to it seems to be hereditary with some persons. Strain- 



302 THE PRACTICE OF MEDICINE. 

ing when at stool, lifting heavy weights or other violent 
exercise are the most common exciting cause. 

Symptoms : In most cases the patient while strain- 
ing at stool or during some kind of violent exercise, 
experiences a sharp pain, which is soon followed by the 
appearance of a soft elastic tumor in the region of the 
groin, or, in some cases in the scrotum. In rare instances, 
the swelling, which is gradual, is the first symptom that 
attracts attention. The tumor is somewhat tender, its 
size varying in different cases. In some, it is exceedingly 
large, while in others, it is small. 

Where the hernia consists of a protrusion of one or 
more loops of the intestine, there may be more or less 
interference with the function of the bowel. Where this 
is the condition there is usually more or less colic, vomit- 
ing and constipation. 

There are certain signs by which hernial tumors may 
be known*; it becomes smaller when the patient assumes 
the recumbent position and larger when standing erect. 
Frequently the tumor disappears entirely during the night. 
A distinct impulse is imparted to the hand, when held 
on the tumor while the patient coughs. 

Scrotal hernia may sometimes be mistaken for hy- 
drocele, but this can usually be obviated by taking the 
patient into a dark room and holding the scrotum between 
the observer and a bright light. If it is hydrocele, there 
will be more or less translucency, which is absent in scro- 
tal hernia. 



HERNIA. 303 

In strangulated hernia the first symptoms are sore- 
ness in the region of the hernial tumor, which is usually 
accompanied by colicky pains and a feeling of tightness, 
generally attended by an accumulation of gas and dis- 
tention of the abdomen. There is also a constant desire 
to evacuate the bowels, but the patient's efforts avail 
nothing. Vomiting soon occurs; the vomited material 
first consisting of the ordinary contents of the stomach, 
but afterwards of the contents of the bowels which has a 
characteristic faecal odor. 

The patient soon becomes greatly prostrated; the pulse 
quick and feeble; the skin pale; the extremities cold; and 
the patient restless and exhibiting great anxiety. If relief 
is not obtained, mortification of the protruded knuckle 
of intestine ensues; there is hiccough; the patient be- 
comes easier and flatters himself by believing that he is 
better; but a condition of collapse ensues, soon termin- 
ating in death. 

Treatment: Return the protruding intestine into 
the abdominal cavity at once. This may be more easily 
accomplished by placing the patient in the recumbent 
position. An appropriate truss should be procured and 
applied, never removing it except to wash the parts, when, 
the patient should be in a horizontal position. 

In order to obtain a truss that is applicable to the 
case consult a competent surgeon. 

By strictly observing the foregoing instructions a 
permanent cure is sometimes effected in young sub- 
jects. 



304 THE PRACTICE OF MEDICINE. 

Umbilical hernia, in infants, may usually be perma- 
nently cured by the constant wearing of a suitable truss. 
It is bad policy to experiment with cheap substitutes, 
as a bullet or a button in a bandage. 

A truss should never be applied to a irreducible her- 
nia, but when the tumor is large a suspensory apparatus 
should be worn. An irreducible hernia may become 
strangulated. In such cases the constriction must be 
overcome by an operation, but the adhesions should not 
be broken as there is great danger of wounding the 
intestine when this is undertaken. 

Strangulated hernia may usually be relieved by 
the proper manipulation or taxis while the patient is 
thoroughly under the influence of Chloroform or Ether. 
Should this method fail, no time is to be lost in perform- 
ing an operation for the purpose of relieving the knuckles 
of strangulated intestine, though no one, under any cir- 
cumstances, but a competent surgeon should undertake 
the operation. 

Surgeons operate with the view of making a perma- 
nent cure of hernia, but where the intestine can be kept 
in place with a truss the operation is hardly justi- 
fiable. 

The injection method of treating hernia is still attract- 
ing some attention and numerous permanent cures are 
reported by its use. It consists of the injection of an irri- 
tant astringent fluid into the canal through which the 
intestine passes. There is no reason why this method 
should not be comparatively safe. 



ILEUS. 305 

ILEUS. 

INTESTINAL OBSTRUCTION. 

Ileus or intestinal obstruction is a gradual or sudden 
closure of some part of the intestinal canal; character- 
ized by deep-seated pain, nausea, stercoraceous vomit- 
ing and obstinate constipation, followed sooner or later 
by collapse. 

The numerous causes of it are as follows: 

1. "Accumulations within the bowel, of hardened 
fasces, or foreign bodies." 

2. " Strictures, the result of cancer, ulceration, or 
cicatrices." 

3. " Pressure against the bowel, from peritoneal 
adhesions, tumors, and abnormal growths." 

4. "Strangulations, due to the numerous forms of 
hernia." 

5. "Invagination or intussusception, the most com- 
mon." 

6. "Twisting, volvulus or rotations of the bowels." 
"Invagination is the only form calling for special de- 
scription. It is usually caused by the lower portion of 
the ilium slipping down into the caecum, as the finger 
of a glove might be invaginated, causing thus an actual 
mechanical obstruction. This is produced by a spasm 
of the ilium, whereby its calibre is greatly diminished, 
thus permitting its descent into the lower bowel. Result- 
ing from this occlusion or compression, are congestion, 
inflammation, with secondary constitutional reaction and 
death, or more rarely the invaginated bowel sloughs off 



306 THE PRACTICE OF MEDICINE. 

and is voided by stool, union taking place at its site and 
recovery following." — Hughes. 

Symptoms: Intestinal obstruction usually commences 
with constipation attended by soreness, colicky pains 
and distention of the abdomen. These symptoms are 
soon followed by nausea and vomiting; the vomited mat- 
ter first consisting of the ordinary contents of the stomach, 
mixed with, more or less bile, and, afterwards, of faecal 
matter, especially where the obstruction is low down. 
Where it is high up there is generally hiccough with sup- 
pression of urine. 

In some cases, especially where the obstruction is the 
result of invagination or intussusception, there are small 
stools, consisting principally of blood, mucus and pus. 

As the disease advances the pulse becomes weak, 
sometimes irregular; the eyes sunken; the skin cold and 
covered with clammy perspiration. 

This condition lasts a variable length of time, though 
where relief is not obtained death usuallv closes the scene 
within ten days, frequently less time. 

Treatment: As soon as the nature of the attack 
is discovered, all cathartics must be discontinued and 
from the J to a J of a grain of the Sulphate of Morphine 
given in order to control the pain, repeating the dose as 
the urgency of the case demands, using care, however, 
not to introduce a sufficient amount of the drug into the 
system at one time to act as a poison. 

The nausea and vomiting must be relieved as much 
as possible, with Creosote Compound Tablets, Subni- 



TAENIA. 307 

trate of Bismuth, Mint, Carbo Ligni, etc. See Irritation 
of the Stomach. 

In order to overcome the obstruction, large injections 
of warm soap-suds should be used occasionally. Should 
these fail to give the desired relief, the bowel may be dis- 
tended with air by means of an ordinary syringe. This 
may be accomplished by allowing a small amount of 
water to enter the syringe for the purpose of causing the 
valves of the syringe to work properly. The writer suc- 
ceeded very nicely in relieving a patient who was suffer- 
ing with intestinal obstruction, which he believed resulted 
from intussusception or invagination, by this method. 

Where the obstruction is the result of hardened or 
impacted faeces in the rectum, it may be removed with 
a spoon-handle or other such article. 

In some cases surgical interference offers the only 
hope of relief, therefore, when the foregoing means fail 
a competent surgeon should be consulted at once. 

INTESTINAL PARASITES. 

WORMS. 

There are three varieties of these that are quite com- 
mon; the tape-worm, the round worm and the thread 
or pin- worm. 

TAENIA. 

TAPE-WORM. 

"There are three varieties of tape-worms commonly 
met with in man, and they are introduced into the intes- 
tines by eating imperfectly cooked pork, beef and fish. 
These worms are flat, made up of little links or joints, 



3 o8 THE PRACTICE OF MEDICINE. 

and are usually of immense length. They are most fre- 
quently met with in adults though they are sometimes 
found in children. 

"Sometimes the first evidence of the presence of a 
tape-worm is the appearance of segments of it in the stools 
and with nervous persons this knowledge causes great 
anxiety and worry. Generally, however, there is a feel- 
ing of lassitude, colicky pains in different parts of the 
abdomen, itching of the nose and anus, palpitation of 
the heart and occasional faintness. The digestion is 
deranged, the appetite being generally inordinate with- 
out satisfying the hunger while emaciation is usually pres- 
ent, the special senses are impaired, the breath has a 
peculiarly disagreeable odor, wakefulness is persistent, 
and there are occasional attacks of bleeding from the 
nose." 

"In nervous persons, sometimes paroxysms or spasms 
of various kinds occur. Cramps and pains in the 
extremities, St. Vitus' dance, hysteria, and even spasms, 
resembling epilepsy, may be developed." 

"While the presence of a tape-worm may be suspected, 
the segments in the passages from the bowels give us the 
only positive evidence of its presence." — Gunn. 

Treatment: The evening before the remedy for the 
expulsion of the worm is to be given in the morning, give 
a full dose of Salts and if it does not act freely on the 
bowels repeat the dose. Allow the patient to eat no sup- 
per and administer the following, on an empty stomach 
early next morning: 



ASCARIS LUMBRICOIDES. 309 

Tannate of Pelletierine, 5 grains, 

Oleoresin of Male Fern, 4 drops, 

Chloroform, 20 drops, 

Syrup of Gum Arabic, 1 ounce. 

Mix and give at one dose requiring the patient to drink 
a glass of sweet milk immediately afterwards. In an 
hour and a half or two hours give a full dose of Salts. 
Keep a vessel of warm water handy and when the patient 
gets up to stool require him to sit in the water. This 
prevents the worm's detecting the difference in its sur- 
roundings. Do not pull on the worm or touch it with 
the hands. If directions are carefully followed you will 
rarely ever fail to be successful. 

The common Pumpkin Seed (Pepo) has been used 
with marked success in these cases. They may be pre- 
pared by depriving 2 ounces of the seed of their capsules, 
then, beating them to a pulp, adding sugar and water, 
when, they may be administered at one dose. In two 
hours administer a full dose of Oil. Use a vessel of 
warm water as previously directed. Prepare the system 
as previously directed. 

ASCARIS LUMBRICOIDES. 

LARGE ROUND WORMS. 

This is one of the most common varieties of worms, 
and is usually met with in children from five to ten years 
of age, however, adults are by no means exempt from 
them. They are developed in the intestines after the 
entrance of the eggs, which are introduced by means of 
food and drink. 



3 io THE PRACTICE OF MEDICINE. 

Their form is cylindrical, rather pointed at the extrem- 
ities; varying in length from four to twelve inches; and 
about the thickness of an ordinary goose-quill, and greatly 
resembling a large earth-worm. They are to some ex- 
tent translucent and of a yellowish or reddish color. They 
inhabit, principally, the small intestines, though, they 
may and frequently do migrate to other parts. 

Symptoms: A variety of symptoms have been enum- 
erated which are claimed to indicate the presence of worms, 
such as bloating of the abdomen, softness or flabbiness 
of the muscles, itching of the nose and anus, swelling of 
the upper lip, the appearance of a white line around the 
mouth, grinding of the teeth and restlessness during sleep, 
bad breath, irregular appetite, and the presence of worms 
in the stools. Any or all of these symptoms may occur 
without the presence of worms, and worms may be pres- 
ent with but few of these symptoms. It is impossible 
to say, even when they are present in the faeces, but that 
all have been discharged. 

Treatment: One of our most efficient remedies for 
the removal of large round worms is Santonine. It should 
be given with sugar thus: 

Santonine, 4 grains, 

Sugar, i teaspoonful. 

Mix and divide into two powders. Give one at bed- 
time, the other an hour before breakfast and in two or 
three hours give a full dose of Oil. 

The following is also an excellent remedy in these 
cases; 



OXYURIS VERMICULARIS. 311 

Oil of Wormseed, 2 drachms, 

Oil of Tansy, J drachm, 

Spirits of Turpentine, 1 drachm, 

Castor Oil, 1 ounce, 

Olive Oil, sufficient to make, 6 ounces. 

Mix and give from ten drops to a teaspoonful, owing 
to the age of the patient, three times a day an hour 
before meals. 

OXYURIS VERMICULARIS. 

THREAD OR PIN-WORMS. 

This variety of worms takes its name from its resem- 
blance to an ordinary piece of thread. It measures from 
an eighth to a half-inch in length. . This, similar to the 
preceding variety, is thought to gain entrance into the 
intestines by mean of the food and drink. They are 
usually met with in children, though, all ages are subject 
to them. 

These worms inhabit the rectum, and not infrequently, 
in females, migrate to the vagina and develop there in 
great numbers. 

Symptoms : These are intense itching and burning 
of the anus with a desire to go to stool, the discharge 
frequently containing mucus, sometimes streaked with 
blood. 

In females .these worms migrate to the vagina, when 
there is intolerable itching of the part. 

. Treatment: In addition to the treatment recom- 
mended for the large round worms use any one of the 
following prescriptions : 



312 THE PRACTICE OF MEDICINE. 

Quassia Chips, i ounce, 

Warm Water, i pint. 

Mix and after keeping warm for a half a day strain 
and use as an injection after cleansing the bowel thor- 
oughly with soap-suds, or: 

Carbolic Acid, i drachm, 

Water, i pint. 

Mix and use two or three times a day as an injec- 
tion, or: 

Common Salt, i ounce, 

Water, i pint. 

Mix and use as an injection two or three times a day. 
Either of the foregoing prescriptions is efficient, but 
the Quassia is probably the best. 

TRICHINA SPIRALIS. 

This is a peculiar parisite and it sometimes infests 
the human body in great numbers. It was discovered 
by Owen, in 1835. They are developed in the alimentary 
canal, but perforate these tissues and migrate into the 
muscles, there becoming encysted. They are introduced 
into the system by eating the raw or imperfectly cooked 
flesh of the infected hog. 

Trichinae are sometimes found in pork in almost 
innumerable numbers. Dr. Sutton, of Indiana, claims 
to have found eighty thousand of them in a piece of pork 
the size of a cubic inch. Their detection is impossible 
without the aid of a microscope. 

Symptoms: These are nausea, vomiting and a watery 
diarrhoea followed by a typhoid-like type of fever, red, 



ACUTE PERITONITIS. 3T3 

swollen face, profuse sweats, with muscular soreness and 
tenderness, increased by motion. If only a few parasites 
have been ingested, recovery may soon take place, but 
where the number was great the patient sinks, day by 
day, until death closes the scene. 

Treatment: The trouble may be entirely avoided 
by eating no raw or imperfectly cooked pork or bacon. 
Emetics and cathartics may be freely administered, for 
three or four days after eating the infected meat, with 
the hope of removing them from the stomach and bowels. 
After this, the case must be treated on general principles, 
however, the treatment recommended for typhoid fever 
would probably be suitable in this condition. 

ACUTE PERITONITIS. 

ACUTE INFLAMMATION OP THE PERITONEUM. 

This is an acute inflammation of the peritoneum, or 
membrane lining the cavity of the abdomen; character- 
ized by fever, intense pain, tenderness, tympanites, con- 
stipation, vomiting and great prostration. 

When the inflammation involves only a part of the 
peritoneum it is called local peritonitis and when it 
involves the entire membrane it is known as general 
peritonitis. 

Its most common . causes are wounds, especially pene- 
trating, of the abdomen, inflammation or perforation 
of the stomach, intestines, gall or urinary bladder, vermi- 
form appendix or surrounding parts, hernia, erysipelas, 
inflammation of the womb, septicaemia, pyaemia; the 



314 THE PRACTICE OF MEDICINE. 

entrance of pus, faecal matter, etc., into the peritoneal 
cavity from any cause, and it not infrequently follows 
confinement, in a violent form. It is through the condi- 
tions just mentioned (and others) that micro-organisms gain 
entrance into the peritoneal cavity and produce the disease. 
There are a variety of these micro-organisms that are 
thought to be capable of inducing peritonitis, as : The 
tubercle bacillus, the staphylococcus pyogenes aureus, 
the bacterium commune, which is always present in the 
intestines; the streptococcus pyogenes, the pneumococcus, 
anthrax bacillus, etc., etc. 

Symptoms: In some cases an attack commences with 
a well-marked chill, followed by fever, quickened pulse, 
intense pain of a cutting or boring character, distention 
and extreme tenderness of the abdomen. 

In other cases, especially those resulting from an 
inflammation of other parts, or perforation of the stomach, 
intestines, or other organs, the attack commences with 
severe local pain, which gradually extends over the entire 
abdomen. In recently delivered females it is not infre- 
quently mistaken for after-pains. 

The bowels are usually obstinately constipated, how- 
ever, in some cases diarrhoea is present. Nausea, vomit- 
ing and hiccough, are usually present. The abdomen 
becomes greatly distended; and the patient lies on the 
back with the legs drawn up in order to lessen the tension 
of the abdominal muscles. Tenderness of the region 
of the abdomen is now extreme and is greatly aggravated 
by coughing, movements, or pressure. 



ACUTE PERITONITIS. 315 

These symptoms continue for six or eight days when 
effusion occurs. The pain and soreness now gradually 
subside and a tedious convalescence ensues; or the symp- 
toms are aggravated; the pulse becoming weak and 
thready; the surface cold and covered with a clammy per- 
spiration and there is collapse. The expression is now 
anxious ; the eyes sunken ; the features pinched ; the upper 
lip drawn; the pulse imperceptible at the wrists and death 
shortly closes the scene. 

Treatment: Where there is fever with a full strong 
pulse, and no irritation of the stomach, the treatment 
should be commenced by the administration of Veratrum, 
and if there is flushed face, with bright eyes and contracted 
pupils, add Gelsemium, thus: 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half 
while there is fever. If the stomach is irritated give 
Aconite instead of the Veratrum, adding the Gelsemium 
if it is indicated; or if the patient is drowsy, the pupils 
being too large, give Belladonna instead of the Gel- 
semium, thus: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, .18 teaspoonfuls. 

Mix and give a teaspoonful everv hour and a half 
or two hours while there is fever. 



316 THE PRACTICE OF MEDICINE. 

Where the pulse is weak or irregular give the following 
instead of the Aconite or Veratrum: 

Fl. Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grand., 24 drops, 

Water, 12 teaspoonf uls. 

Mix and give a teaspoonful every two hours while 
the pulse is weak. 

Keep the bowels open with Salts, in half-tablespoonful 
doses, every two or three hours as is required, aided by 
enemas of warm soap-suds. 

For the purpose of controlling the pain give J of a 
grain of the Sulphate of Morphine, hypodermically, every 
two or three hours as is required. 

Hot poultices should be applied to the abdomen at 
short intervals. Instead of these, clothes wrung out of 
hot Turpentine-water may be used, frequently changing 
them. 

If the tongue is broad, pallid, and coated with a filthy, 
pasty coat, give 15 or 20 grains of the Sulphite of Soda 
every three or four hours. 

If the urine is scanty give 15 or 20 drops of the Acetate 
of Potash every three or four hours. 

If the stomach is irritable small lumps of ice may be 
given occasionally. Where this fails to relieve the stomach 
a Tablet of Creosote Compound may be given every hour. 
See Irritation of Stomach. 

Where there is any suspicion of a perforation of the 
stomach, intestines, gall or urinary bladder, call a com- 
petent surgeon at once as the case is exceedingly dan- 



CHRONIC PERITONITIS. 317 

gerous. A laparotomy may not save the patient but it 
offers about the only hope. 

As peritonitis is one of our most dangerous diseases 
it is not advisable for the unprofessional reader to 
attempt to treat it in any of its forms. 

The diet should consist of soups, teas, egg-white, etc. 

CHRONIC PERITONITIS. 

CHRONIC INFLAMMATION OF THE PERITONEUM. 

Chronic peritonitis is a chronic inflammation of the 
peritoneum or lining membrane of the abdomen; char- 
acterized by pain, tenderness, emaciation and sometimes 
fever, followed by an effusion of liquid into the peritoneal 
cavity. It may occur as a sequel to the acute form of 
the disease, but it is more commonly met with as a result 
of cancer, or tuberculosis of the bowels, Bright's disease 
of the kidneys or sclerosis of the liver. 

The disease is most frequently seen in children, but 
all ages are subject to it. 

Symptoms: These are irregular chills, and fevers 
followed by sweats with pain, tenderness, and more or 
less dropsical swelling of the abdomen, especially where 
it is a result of the acute form of the disease. Con- 
stipation alternated with diarrhoea and followed, sooner 
or later, by emaciation and debility, is characteristic. 
"Usually the lower portion of the abdomen gives a dull 
note on percussion, from the presence of fluid, or scattered 
points of dullness, showing the presence of encysted fluid." 
Almost, if not quite all, of these cases finally terminate 
fatally. 



318 THE PRACTICE OF MEDICINE. 

Treatment : The following is beneficial in these cases. 

Iodide of Potash, i ounce, 

Fl. Ext. of Apocynum Can., 3 drachms, 

Compound Syr. of Stillingia, suffi- 
cient to make, 6 ounces. 

Mix and give a teaspoonful three times a day after 
meals. 

Counter-irritation is also an important remedy in 
these cases, and nothing answers a better purpose than 
the Compound Tar Plaster. . It should be applied to 
the abdomen and worn as long as the patient can bear 
it, when, it should be removed until the parts have healed 
to some extent and then, applied again and continued 
in this manner for a long time. 

Where the patient is debilitated give stimulants, a 
nutritious diet and the following tonic: 

Fl. Ext. of Nux Vomica, 3 drachms, 

FL Ext. Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian,. 3 ounces, 

Aromatic Elixir, sufficient to make,. 6 ounces. 

Mix and give a teaspoonful three times a day before 
meals. 

CONGESTION OF THE LIVER. 

" BILIOUSNESS." 

This is an abnormal fullness of the blood-vessels of 
the liver; characterized by loss of appetite, fullness and 
soreness in the region of the liver, followed by slight 
jaundice. 



CONGESTION OF THE LIVER, 319 

The most common causes of it are exposure to 
excessive heat, constipation of the bowels; the immoderate 
use of spirituous liquors, overindulgence at the table, 
malaria, and diseases of the heart and lungs. 

Symptoms: These are loss of appetite; a yellowish 
coated tongue; sometimes nausea and vomiting; aching 
of the limbs; headache, evening fevers, scanty high-colored 
urine, and a feeling of fullness and soreness in the liver, 
followed by slight jaundice. 

Treatment: Where an attack is caused by a heart 
or lung-disease it may be relieved by removing its cause. 

Where it results from other causes, the treatment may 
be commenced by the administration of Oil, Salts or a 
Seidlitz Powder. If there is a yellowish coating on the 
tongue, the following should be given: 

Calomel, 1 grain, 

Bicarbonate of Soda, 10 grains, 

Powd. Ipecac, 1 grain. 

Mix, divide into five powders and give one every hour. 
If they fail to act mildly on the bowels follow them with 
Oil, Salts or a Seidlitz Powder. 

Nausea and vomiting when present may usually be 
relieved by counter-irritation over the region of the stomach 
and the administration of the Creosote Compound Tablet 
every hour. See Irritation of the Stomach. 

The pain is sometimes quite severe. In such cases hot 
applications may be applied over the region of the liver. 
Should these fail to afford relief J of a grain of the Sulphate 
of Morphine may be given, preferably, hypodermically. 



3 2o THE PRACTICE OF MEDICINE. 

When fever is present it should be controlled with 
sedatives administered according to indications. If it 
is high, Acetanilide may also be given. If the fever is 
periodic give Quinine as is recommended for intermittent 
fever. 

If there is scantiness of urine give the following: 

Acetate of Potash, \ ounce, 

Water, sufficient to make, 2 ounces. 

Mix and give a teaspoonful, in a sup of water every 
three or four hours until the desired effects are ob- 
tained. 

Where there is yellowness of the skin and eyes 
(jaundice), give the following: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Chionanthus Virg., 3 ounces, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Aromatic Elixir, sufficient to make, .6 ounces. 
Mix and give a teaspoonful three times a day before 
meals. 

In persons, who are predisposed to congestion of the 
liver, the diet and habits must be well regulated, and if 
there is constipation of the bowels it must receive appro- 
priate treatment. 

HEPATITIS. 

INFLAMMATION OF THE LIVER. 

Hepatitis is an inflammation of a part, rarely, if ever, 
of the entire substance of the liver; characterized by fever, 
pain and tenderness in the region of this organ and in 
some cases the formation of an abscess. 



HEPATITIS. 321 

It may result from a variety of causes, the most common 
of which, are exposure to cold, blows or wounds in the 
region of the liver; high-living, intemperance, intense 
summer heat, malaria, ulcers of the stomach; and the 
absorption of putrid material by the portal radicles in 
dysentery. 

Symptoms: An attack is usually ushered in with a 
chill or rigor, followed by fever, nausea, vomiting, pain 
and tenderness in the region of the liver, varying in inten- 
sity, being more severe when the peritoneal covering of 
the organ is involved. Not infrequently the pain extends 
to the right shoulder. As the disease advances, the skin 
becomes hot and dry; the pulse full and quick; the urine 
scanty and high-colored; the bowels constiDated; and 
the tongue usually coated with a yellowish fur. 

In some cases, especially where that portion of the 
liver next to the diaphragm is involved, the lung becomes 
irritated, producing more or less cough and sometimes 
difficult breathing. 

During the first few days of an attack, the fever is 
remittent, the remissions usually occurring of a morning, 
though, they are sometimes not well marked. 

The inflammation continues from eight to twelve 
days and terminates in recovery or the formation of an 
abscess, which may, and not infrequently does, terminate 
in death. When the inflammation terminates in the 
formation of an abscess, the pain becomes less severe and 
of a throbbing character; there are chills or rigors at 
irregular intervals, followed by fevers and profuse sweats. 



322 THE PRACTICE OF MEDICINE. 

The pus may be discharged into the stomach, the 
intestines, the peritoneal cavity, through the pleura into 
the lungs, or externally. 

Treatment: Control the fever. Sedatives adminis- 
tered according to indications will usually do this very 
nicely, however, where the fever runs high, Acetanilide 
should also be given. 

As a sedative to the liver Calomel is probably our 
best remedy. It may be given as follows: 

Calomel, i grain, 

Powd. Ipecac, i grain, 

Bicarbonate of Soda, 10 grains. 

Mix, divide into five powders and give one every hour. 
This may be repeated each day during the attack. Should 
the Calomel fail to keep the bowels open, Oil, Salts or 
Seidlitz Powders should be used for this purpose as is 
required. 

Nausea and vomiting, when present, may usually 
be controlled by means of counter-irritation over the 
stomach in the form of a Mustard-Plaster and the admin- 
istration of a Creosote Compound Tablet every hour. 

For the relief of pain hot poultices or hot salt may 
be applied to the painful part. 

If the urine is scanty, give the following: 

Acetate of Potash, § ounce, 

Water, sufficient to make, 2 ounces. 

Mix and give a teaspoonful, in a sup of water, every 
three or four hours until the desired effects are ob- 
tained. 



CIRRHOSIS OF THE LIVER. 323 

In malarial districts, during the remissions, which 
usually occur of a morning, 5 grains of the Sulphate of 
Quinine should be given every two hours. 

Where the inflammation terminates in the formation 
of an abscess, the pus must be removed with an instrument 
called an aspirator, or by a free incision and the system 
supported with the following: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make,. 6 ounces. 
Mix and give a teaspoonful three times a day before meals. 

CIRRHOSIS OF THE LIVER. 
gix-drlnker's liver. 

This is a chronic inflammation of the intervening 
connective tissue of the liver, resulting in hardening and 
atrophy of this organ; characterized by emaciation, slight 
jaundice, gastro-intestinal catarrh, and dropsy of the 
abdomen. 

It is caused by syphilis, also the prolonged use of beer 
and alcoholic stimulants. 

Symptoms: The disease always terminates, sooner 
or later, in death, yet no definite symptoms occur until 
abdominal dropsy makes its appearance, however, attacks 
of persistent vomiting and diarrhoea, with slight jaundice, 
are suspicious in drinking men. 

As the disease advances, there is indigestion; slight 
jaundice; increasing emaciation; enlargement of the 
superficial abdominal veins; hemorrhage from the stomach 



324 THE PRACTICE OF MEDICINE. 

and bowels; great distention of the abdomen and more 
or less difficulty in breathing. 

In some cases there is dropsical swelling of the feet 
and legs, but this generally results from some coincident 
heart or kidney-disease. 

Treatment: Regulate the diet, prohibiting fatty and 
saccharine articles; and also spirituous liquors. If diges- 
tion is feeble, give the following: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

FL Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make,. .6 ounces. 

Mix and give a teaspoonful three times a day before 
meals. When jaundice is present, from 20 to 30 drops 
of the Fl. Ext. of Chionanthus Virginica should be added 
to each dose of the foregoing. 

The Phosphate of Soda should be given in from \ 
to 1 -drachm doses after meals. The Iodide of Potash, 
in 10-grain doses, three times a day, is thought to be 
beneficial. Calomel is recommended, but we think 
without good reasons. 

Where complications, such as constipation, dropsy, 
hemorrhage, heart, or kidney-disease, arise, appropriate 
treatment for their relief, as is recommended elsewhere 
in this work, should be adopted. 

BILIARY CALCULI. 

gall-stones; hepatic colic. 

Gall-stones are concretions formed in the gall-bladder 
or biliary ducts, composed partly, or entirely, of the con- 



BILIARY CALCULI. 325 

stituents of the bile, and varying in size from a pin-head 
to a hen-egg. They may remain within the gall-bladder 
a long time, and yet produce no symptoms, which would 
lead to their recognition, until the passage of one or more 
of them is attempted, when an attack of what is known 
as hepatic colic ensues. Cancerous growths, or tumors, 
in the gall-bladder or liver; inflammation of the gall- 
bladder, constipation, tight-lacing, pregnancy or any 
trouble that interferes with the flow of bile, are thought 
to predispose to their development. It is a disease of 
middle life, however, they are met with in children and 
young persons. Women are more subject to them than 
men. Gilbert and Fouriner claim to have produced 
them experimentally by injecting micro-organisms into 
the gall-bladder of animals. 

Symptoms: An attack commences suddenly, when 
a stone passes from the gall-bladder into the cystic duct, 
with cutting, agonizing pains in the region of the gall- 
bladder and soon extending to the abdomen and right 
chest. They are of a remittent character and continue 
from one or two hours to several days, or until the stone 
is passed. 

Nausea and vomiting are almost always present; the 
pulse is small and feeble; the skin cool and pale; the 
expression anxious, with, in some cases, chills, trembling, 
fainting, or convulsions. Jaundice usually makes its 
appearance during or after an attack. As soon as the 
stone reaches the duodenum, the pain ceases suddenly; 
the nausea, vomiting, soreness and jaundice soon subside 



326 THE PRACTICE OF MEDICINE. 

and the patient is convalescent, however considerably 
debilitated. 

Where the stone becomes impacted there is ulcerative 
perforation with consequent peritonitis, the stone dis- 
charging into the intestine, stomach, or through the 
abdominal wall. 

Treatment: The pain may be controlled with the 
Sulphate . of Morphine in doses of \ grain, preferably 
hypodermically, every hour or so as the urgency of the 
case demands, being careful, however, not to introduce 
a sufficient quantity of it into the system at one time to 
act as a poison. 

Instead of the Morphine, 20 to 30 drops of Chloro- 
form, largely diluted with sweetened water, may be given 
every twenty or thirty minutes. When the pain is very 
excruciating the Chloroform may be used by inhalation, 
however, when used in this manner, it is necessary to 
exercise the greatest of care. 

The Fl. Ext. of Gelsemium, in 10-drop doses every 
forty minutes until the pain is relieved, or until drooping 
of the eyelids or double vision is produced, is highly 
recommended in these cases for relieving the pain and 
sometimes gives excellent results. 

The application of hot poultices, or clothes wrung 
out of hot water, removing them frequently, is very bene- 
ficial and their use should not be neglected. 

The stones having passed into the intestine, which 
may be inferred by the cessation of pain for some time, 
a full dose of Oil, Salts or Seidlitz Powder, should be 



ICTERUS. 327 

given in order to obtain an action from the bowels, thus 
hastening the stone's removal as well as the discharge 
of the accumulated bile. 

Where there is jaundice from 20 to 30 drops of the 
Fl. Ext. of Chionanthus Virginica should be given four 
times a day. 

With a view of preventing a reformation of the stones 
Phosphate of Soda should be given three times a day in 
doses from \ to 1 drachm, regulating the dose, however, 
according to its effect on the bowels. In order to be 
successful its use should be continued for a long time. 

Where the stone, or stones, in the gall-bladder are 
large, surgery offers the only hope of a cure. 

ICTERUS. 

JAUNDICE. 

This is a condition in which there is an undue amount 
of bile in the system; characterized by itching and yellow- 
ness of the skin and eyes, with light or clay-colored stools 
and high-colored urine. 

It is not, really, a disease within itself, but only a 
symptom of some morbid condition of the liver or gall- 
ducts. 

The principal cause of jaundice is the non-removal 
of the bile from the blood by the liver, and some obstruc- 
tion, such as the presence of gall-stones, tumors, or an 
inflammation of the gall-ducts, preventing the transit of 
bile after secretion, thus causing its re-absorption into 
the blood. 



328 THE PRACTICE OF MEDICINE. 

Symptoms : Jaundice usually commences with a feeling 
of languor, loss of appetite, flatulency and constipation. 
As the disease advances, there is yellowness of the eyes, 
skin and nails, headache, itching of the skin; more or 
less pain and tenderness in the region of the liver; bitter 
taste in the mouth; and the tongue coated with a yellow 
fur. There is usually nausea and vomiting, high-colored 
urine and whitish or light-colored discharges from the 
bowels. 

The pulse, in some cases, is unaffected, while in others 
it is quickened, especially in those cases where there is 
fever. When fever is present it is usually of a remittent 
type and may continue a week or more. 

Yellowness of vision is common. This is caused by 
the humors of the eyes becoming tinted with bile. 

The duration of an attack is extremely varied, ter- 
minating in some cases, within a few days, while in others 
it continues for months, however, this is exceedingly rare 
except in badly, or improperly treated cases. 

Treatment: If fever is present control it with 
sedatives administered according to indications. If the 
fever is periodic administer Quinine as is recommended 
in remittent fever. 

If the bowels are constipated administer Oil, Salts 
or a Seidlitz Powder; or if the tongue is coated with a 
yellowish coat, give the following: 

Calomel, i grain, 

Powd. Ipecac, i grain, 

Bicarbonate of Soda, 10 grains. 



ICTERUS. 329 

Mix, divide into five powders and give one every hour. 
This prescription may be repeated every day for a few 
days. 

' As soon as the disease makes its appearance, when 
there is no fever, the following should be given: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastic Can., 1 ounce, 

FL Ext. of Chionanthus Virginica ? -3 ounces, 
Aromatic Elixir, sufficient to make,. 6 ounces. 
Mix and give a teaspoonful before each regular meal. 
If the pain in the region of the liver is severe, hot 
poultices, hot salt, or clothes wrung out of hot water, may 
be applied. 

If the urine is scanty give the following: 

Acetate of Potash, \ ounce, 

Water, sufficient to make, 2 ounces. 

Mix and give a teaspoonful every four hours until 
the desired effects are obtained. 

In chronic cases, or where the affection comes on 
slowly, alteratives should be given, thus: 

Iodide of Potash, 1 ounce, 

Compound Syr. of Stillingia, to make, ... 6 ounces. 
Mix and give a teaspoonful three times a day after 
meals. 

The continued use of counter-irritation, in the form 
of the Compound Tar Plaster, over the region of the liver, 
answers an excellent purpose in these cases. Should 
the means here recommended fail to effect a cure, no time 
should be lost in consulting a competent physician. 



330 THE PRACTICE OF MEDICINE. 

SPLENITIS. 

INFLAMMATION OF THE SPLEEN. 

Splenitis is an inflammation of the substance, and 
not infrequently the peritoneal covering of the spleen; 
characterized by fever, pain, tenderness and more or less 
swelling of this organ. It is a very rare disease, the 
writer, in a practice extending over more than twenty years, 
never having seen but three cases of it. 

It may result from an obstruction of the circulation 
of the organ by a blood-clot in its vessels, or from violence, 
malaria, or the same causes that give rise to inflammation 
in other organs. 

Symptoms: An attack usually commences with a 
well-marked chill, followed by fever, thirst, an accelerated 
pulse; pain and tenderness in the left side in the region 
of the spleen. Where only the substance of the spleen 
is involved, the pain is dull, but where the peritoneal 
covering is involved, it is severe and cutting. The pain, 
in some cases, extends over the entire abdomen and 
sometimes into the left shoulder. A dry cough is present 
in a majority of cases, and this greatly aggravates the 
patient's suffering. 

The bowels are constipated; the urine scanty and 
high-colored; the tongue is coated with a whitish or a 
yellowish fur; and in many cases there is nausea and 
vomiting. In some cases the affected side is enlarged 
on account of the swelling of the spleen, which may be 
felt through the abdominal walls. 



SPLENITIS. 331 

The fever is usually, if not always, of a remittent type, 
however, as the disease advances it may become con- 
tinuous. 

Inflammation of the spleen usually terminates in a 
restoration of the organ to its normal condition, however, 
in some cases, especially severe ones, it may terminate 
in the formation of an abscess, which may be recognized 
by the pains becoming less severe and of a throbbing 
character. 

Treatment : Control the fever with sedatives adminis- 
tered according to indications and if the fever is high and 
the pulse strong Acetanilide may also be given. 

If there is a yellowish coating on the tongue give the 
following : 

Calomel, 1 grain, 

Powd. Ipecac, 1 grain, 

Bicarbonate of Soda, 10 grains. 

Mix, divide into five powders and give one every hour. 
Should they fail to act mildly on the bowels give Oil, 
Salts or a Seidlitz Powder. If preferred two Improved 
Compound Cathartic Pills may be used instead of the 
Calomel. If they are given, give one, wait four hours 
and give the other one. 

Where the urine is scanty give 15 or 20 grains of the 
Acetate of Potash, or 20 or 30 drops of the Fl. Ext. of 
Buchu every four hours until the desired effects are 
obtained. 

Nausea and vomiting, when present, may usually 
be controlled with counter-irritation, in the form of a 



332 THE PRACTICE OF MEDICINE. 

Mustard-Plaster, over the region of the stomach and 
hourly doses of Creosote Compound Tablets. 

When pain is severe apply hot poultices, hot salt, or 
clothes wrung out of hot water, over the region of the 
spleen, frequently changing them. 

If the fever is of a remittent type, give Quinine during 
the remissions, as is recommended for remittent fever. 

If the fever assumes a continued type, treat it as 
such. 

When the inflammation terminates in the formation 
of an abscess, the pus should be promptly removed by 
an incision or with an aspirator, however, no one but a 
competent surgeon should attempt this. 

HYPERTROPHY OF THE SPLEEN. 

ENLARGEMENT OF THE SPLEEN. 

Hypertrophy of the spleen is an enlarged condition 
of this organ, commonly known as ague-cake. It is a 
result of, or attendant upon, sub-acute or chronic inflam- 
mation. The organ is sometimes enlarged to such an 
extent that it fills the entire cavity of the abdomen. 

It may result from several causes, the most common 
of which is protracted cases of. chronic malaria. 

Symptoms: These, with the exception of the enlarge- 
ment of the organ, which may be distinctly felt through 
the abdominal walls, are obscure, however, there is 
usually a sense of uneasiness, weight or tension, and 
sometimes pain in the left side, with, in most cases, 
shortness of breath, more or less despondency, constipa- 
tion, scanty urine and a whitish coating on the tongue. 



PANCREATITIS. 333 

In advanced stages of the disease the debility is 
extreme; there is loss of appetite, with hectic fever, 
night-sweats, diarrhoea, hemorrhage from the stomach, 
or dropsy, and if relief is not obtained death finally closes 
the scene, however, this termination is usually brought 
about by some intercurrent disease. 

Treatment: See Chronic Intermittent. 
THE PANCREAS. 

This is a gland about six or seven inches long, situated 
behind the stomach and in front of the first lumbar ver- 
tebra. It secretes a fluid known as the pancreatic juice, 
which is emptied through a canal or duct into the duode- 
num just below the stomach. This fluid aids in the 
digestion of fats. 

Diseases of this organ are very obscure, besides, we 
have no known remedy that acts specifically upon it, 
therefore, none of its diseases except inflammation will 
be noticed. 

PANCREATITIS. 

INFLAMMATION OF THE PANCREAS. 

Pancreatitis is an inflammation of the substance of 
the pancreas; probably characterized by fever, a dull, 
deep-seated pain in the region of this organ, often shoot- 
ing to the back and left shoulder. 

The causes of it are very obscure, but it is thought 
that the excessive use of alcoholic liquors or blows over 
the organ may induce an attack, and it may follow cer- 
tain forms of fever. 

Men are more subject to it than women. 



334 THE PRACTICE OF MEDICINE. 

Symptoms : These are obscure ; however, there is 
probably a dull, deep-seated, colicky pain in the region 
of the pancreas, usually extending to the back and left 
shoulder. Fever, with a quickened or irregular pulse, 
intense thirst, more or less difficulty in breathing, con- 
stipation of the bowels, and vomiting of a thin, viscid 
fluid, often mixed with bile, are generally present. 

The. pain is greatly aggravated by firm pressure over 
the pancreas; and there is great anxiety, marked depres- 
sion and symptoms of collapse from the commencement 
of the attack. An attack is usually fatal. 

Treatment: We control an inflammation of the 
pancreas on precisely the same principles that inflamma- 
tion of other organs is controlled, i. e., by controlling 
the circulation and temperature and obtaining free action 
from the excretory organs. The first may be accom- 
plished very nicely by the use of sedatives according to 
indications and the latter by the use of cathartics and 
diuretics. 

Nausea and vomiting, when present, may be con- 
trolled in this, as in other diseases. 



PART VI. 

DISEASES OF THE URINARY APPARATUS, 

INCLUDING DISEASES OF THE MALE 

ORGANS OF GENERATION, AND 

VENEREAL DISEASES. 

THE URINARY APPARATUS. 

This consists of the kidneys, ureters or canals that 
convey the urine from the kidneys to the bladder, and 
the bladder, and the urethra or canal through which the 
urine is discharged. 

The urine is a slightly acid fluid of a light, amber 
color, excreted by the kidneys. The color deepens if 
the quantity voided be decreased, and vice versa. The 
amount of urine excreted by a healthy adult varies from 
forty to fifty ounces in twenty-four hours. It is decreased 
by free perspiration and increased by chilling the sur- 
face. Its normal specific gravity varies from 1.015 to 
1.025; it is greater when the quantity of urine is 
decreased, and lower when it is increased. 

By specific gravity is meant the wxight compared 
with water, thus: If a given quantity weighs 1,000 
grains, the same quantity of normal urine would weigh 
between 1.015 and 1.025 grains. 



336 THE PRACTICE OF MEDICINE. 

The urine is one of the most important excretions 
of the human body, as it is through it that a great deal 
of the waste material, that is no longer necessary for the 
support of animal life, is removed from the system. This 
material, when allowed to accumulate in the body, acts 
as a narcotic poison, and thus not infrequently produces 
death; hence, the importance of its removal. 

RENAL HYPEREMIA. 

CONGESTION OF THE KIDNEYS. 

This is an abnormal fullness of the blood vessels of 
the kidneys; characterized by pain and a frequent desire 
to urinate, the urine being scanty, high-colored, and 
sometimes contains blood or albumen. 

There are two forms of congestion of the kidneys; 
the active and the passive. When the congestion is 
arterial it is active, and when venous it is passive. 

The most common causes of active congestion are 
cold, injuries over the kidneys; irritating substances 
eliminated by the kidneys, as Chlorate of Potash, Tur- 
pentine, Cantharides, Copaiba, Carbolic Acid, etc. 

The passive form is caused by some heart or lung- 
disease that obstructs the circulation, or pressure of the 
pregnant uterus. 

Symptoms: The symptoms of the active form are 
pain over the region of the kidneys, extending into the 
testicle and penis; a frequent desire to urinate, the urine 
being scanty and high-colored and not infrequently con- 
tains albumen or blood. Loss of appetite, headache, 
nausea and vomiting, with a feeling of discomfort, are 



RENAL HYPEREMIA. 337 

usually present. This condition, unless controlled by 
proper treatment, is very liable to terminate in inflamma- 
tion of the kidneys. 

The symptoms of the passive form are at first 
obscure, rarely attracting any attention until a dropsical 
condition, usually beginning in the feet and legs, is devel- 
oped. In rare cases, however, there is persistent head- 
ache, more or less nausea and vomiting. 

The urine, in these cases, is scanty and high-colored, 
and after standing for a few hours a sediment consisting 
of albumen is deposited on the bottom of the vessel con- 
taining it. The test usually relied on for detecting 
albumen in the urine, is to put a half-ounce of the sus- 
pected urine in a test-tube, or a clear vial, and then add 
3 or 4 drops of Nitric Acid to it and hold the test-tube 
or vial over a spirit-lamp, or other lamp, until the urine 
boils. If albumin be present there is a whitish deposit, 
resembling, to some extent, the white of an egg. 

Treatment: If possible ascertain the cause and 
remove it; put the patient to bed and administer a full 
dose of Salts or Seidlitz Powder; apply dry cups or hot 
poultices over the region of the kidneys; allow the 
patient to drink lemonade freely; and if there is irritation 
of the bladder give from 3 to 5-drop doses of the Fl. Ext. 
of Gelsemium every half-hour until three or four doses 
are taken. Should this fail to give relief hot poultices 
may be applied over the region of the bladder and to the 
perineum. 



338 THE PRACTICE OF MEDICINE. 

The passive form is relieved by removing its cause. 
If the heart or lungs are affected appropriate treatment 
should be adopted to overcome any wrong of these organs. 
If the feet and legs are swollen give 3 or 4 drops of the 
Fl. Ext. of Apocynum Cannabinum four times a day. 
Even where the disease is produced by pregnancy the 
Apocynum will usually relieve it. 

ACUTE NEPHRITIS. 

ACUTE INFLAMMATION OF THE KIDNEYS. 

This is an acute inflammation of the substance of 
one or both kidneys; characterized by fever, deep-seated 
pain, retraction of the testicle of the affected side, numb- 
ness of the thigh of the same side, and scantiness of urine, 
with, in most cases, pain and difficulty in passing it. 

The most common causes of it are a sudden chilling 
of the body; the excessive use of alcoholic liquors; the 
improper use of irritating diuretics; the presence of renal 
calculi, and blows over the region of the kidneys. 

Symptoms: An attack commences with a well-marked 
chill or rigor followed by fever and a severe pain in the 
region of the kidneys. In the course of forty-eight or 
seventy-two hours the fever becomes a marked feature 
of the disease. By the second day of the attack the 
pain extends into the testicle, causing retraction of this 
organ, and there is usually more or less numbness of the 
thigh of the affected side. The pain is greatly increased 
by straining at stool or in voiding the urine. 

As the disease advances, the urine, which was but 
little changed at the beginning of the attack, becomes 



ACUTE NEPHRITIS. 339 

scanty and of a dark-red color and is not infrequently 
streaked with blood. If both kidneys are involved, the 
urine becomes very scanty, sometimes, almost, if not 
quite, suppressed, when, there is a low, muttering delirium, 
or stupor and death, as a rule, soon terminates the scene. 
Obstinate constipation, nausea and vomiting, a harsh, 
dry skin and sleeplessness are generally present in these 
cases. 

Where only one kidney is involved and the disease 
progresses until the eighth or tenth day without being 
controlled, the fever assumes a typhoid or continued 
type, when the tongue becomes dark, and sordes appear 
on the lips and teeth. 

These attacks last a variable length of time and not 
infrequently terminate in death. 

This, as well as any other inflammation, may also 
terminate in the formation of pus, which is indicated by 
irregular chills and' fevers followed by profuse perspira- 
tions. 

Treatment: Control the fever. If the pulse is full 
and strong give Veratrum, and where the face is flushed, 
the eyes bright and the pupils contracted, add Gelsemium, 
thus: 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 27 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half or 
two hours while there is fever. If the fever is high, 5 
grains of Acetanilide should also be given every three 



340 THE PRACTICE OF MEDICINE. 

or four hours. If the stomach is irritated give Aconite 
instead of the Veratrum, adding the Gelsemium, if it is 
indicated; or if the patient is drowsy, the pupils being 
too large, give Belladonna instead of the Gelsemium, 
thus: 

Tr. of Aconite Root, 18 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half 
or two hours while there is fever. 

If the pulse is weak or irregular give Digitalis and 
Cactus instead of the Veratrum or Aconite, adding the 
Belladonna, if indicated, thus: 

FL Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grand., 24 drops, 

Fl. Ext. of Belladonna, 6 drops, 

Water, 12- teaspoonfuls. 

Mix and give a teaspoonful every two hours while 
the pulse is weak or irregular. 

Keep the bowels open from the beginning of the 
attack with Salts. 

The action of the foregoing remedies may be aided 
by the employment of a hot sitz-bath, and at the same 
time placing the feet in a vessel of hot Mustard-Water, 
being careful, however, to see that the patient's body 
is not exposed to cold air. After the bath, put the patient 
to bed and apply hot poultices over the region of the kid- 
neys, frequently changing them until relief is obtained. 



CHRONIC NEPHRITIS. 341 

Diuretics should not be given until the more acute 
symptoms have subsided, and, then, only those of a mild, 
unirritating character, such as the Fl. Ext. of Polytri- 
chum, in 30-drop doses every three or four hours. 

If suppuration occurs, support the strength and give 
from 1 -10 to 1-8 of a grain of the Sulphide of Calcium 
every four hours. 

If the fever assumes a continued or typhoid type 
treat it as such. 

The diet in these cases must be light and unstimu- 
lating. 

CHRONIC NEPHRITIS. 

CHRONIC INFLAMMATION OF THE KIDNEYS. 

This is a chronic inflammation of the substance of 
one or both kidneys; characterized by pain, weakness 
of the back, scanty, high-colored urine, emaciation and 
a peculiar appearance of the tongue. 

It may result from the acute form of the disease, but 
it is more commonly induced by other causes, such as 
cold, injuries in the region of the kidneys; the excessive 
use of alcoholic liquors; or irritating diuretics admin- 
istered in the treatment of other diseases. 

Symptoms: There are pain and soreness in the loins, 
worse at some times than at others, and is increased by 
active exercise. At first, there may be very little change 
in the urine, but as the disease progresses, it becomes 
scanty and high-colored and its discharge is usually 
attended by a sensation of more or less burning in the 
urethra. 



342 THE PRACTICE OF MEDICINE. 

In some cases the testicles are retracted; in others, 
there is recurring pain in them or the penis. The bowels 
are usually obstinately constipated, and more or less 
nausea and vomiting are usually present. The tongue 
is, as a rule, red and rather deeply fissured. The pa- 
tient complains of weakness of the back. 

These symptoms continue; there is loss of appetite, 
flesh and strength, but the patient is not yet confined to 
bed. The inflammation may occasionally assume rather 
a sub-acute form, but yields readily to treatment, and 
the patient, though gradually growing weaker, lives in 
hopes of a speedy recovery. This condition lasts a vari- 
able length of time, when, finally, a severe pain occurs 
in the region of the kidneys extending to the testicles; 
the urine becomes scanty and usually contains pus and 
blood; nausea and vomiting are present; the pulse 
becomes weak and thready; the patient passes into a 
profound stupor and death soon closes the scene. 

Treatment: If the bowels are constipated, admin- 
ister a sufficient amount of the Fl. Ext. of Cascara Sa- 
grada before each regular meal to procure one or two 
medium actions from the bowels each day. 

Where the irritation of the kidneys is great give from 
20 to 30 drops of the FL Ext. of Polytrichum (Hair-Cap 
Moss) every four hours; and as the irritation subsides 
such remedies as the Fl. Ext. of Buchu or the Fl. Ext. 
of Hydrangea may be given. In some cases, especially 
where there is mucus and pus in the urine, Balsam of 
Copaiba, in from 10 to 20-drop doses two or three times 



PYELITIS. 343 

a day sometimes answers an admirable purpose. In all 
cases where the urine contains pus from the i-io to the 
1-8 of a grain of the Sulphide of Calcium should be given 
every four hours. 

If the urine is alkaline — and this may be known by 
its changing red litmus paper to blue — 5 drops of Dilute 
Nitric Acid, largely diluted with water, should be given 
every three or four hours; or if the urine is strongly 
acid — and this may be known by its changing blue litmus 
paper to red — Bicarbonate of Soda should be added to 
a glass of water until the taste becomes evident and 
then used as a drink. 

As an external application over the region of the 
kidneys, the Compound Tar Plaster will be found to 
answer a better purpose than any other counter-irritant 
known to the writer. It should be worn almost con- 
stantly if the patient can possibly bear it, and he can. 

The diet must be nutritious, but easy to digest, avoid- 
ing stimulating articles of diet, fats and acids. 

PYELITIS. 

Pyelitis is an inflammation of the mucous membrane 
of the pelvis of the kidneys; characterized by pain in 
the region of the kidneys, a frequent desire to urinate, 
the urine being neutral or acid in reaction and of a 
milky appearance, not infrequently containing pus. 

The most common cause of it is an obstruction of 
the ureters by calculi or tumors; however, inflamma- 
tion of the bladder, especially gonorrhceal, by an exten- 
sion of the inflammation through the ureters, may cause 



344 THE PRACTICE OF MEDICINE. 

it. Cold, exposure, rheumatism, the improper use of 
irritating diuretics, etc., may induce an attack. 

Symptoms: When it arises as a secondary affection 
it is preceded by the symptoms of the disease causing 
it. 

An attack usually begins with chilliness, followed 
by slight fever, pain in the region of the kidneys, extend- 
ing down the ureters and a frequent desire to urinate. 

The urine presents a milky appearance, contains 
more or less pus, and, on standing, deposits a copious, 
yellowish or whitish sediment. In cases arising from 
stones in the pelvis of the kidneys, or in the ureters, 
blood usually appears in the urine. 

In some cases there are irregular chills and fevers, 
followed by profuse sweats; while in others, there is a 
continued or typhoid type of fever, however, these con- 
ditions are not met with in all cases. 

Where both kidneys are involved, uraemic poisoning 
may occur. 

Treatment: Control the fever with sedatives admin- 
istered according to indications. If the urine is markedly 
acid in reaction, which is usually the . case, administer 
a solution of Bicarbonate of Soda as a drink. 

If the inflammation is a result of the presence of 
renal calculi 20 drops of the Fl. Ext. of Hydrangea should 
be given every four hours; or where it is caused by an 
extension of an inflammation of the bladder, 20 to 30 
drops of the Fl. Ext. of Chimaphila should be [given 
three times a day before meals. 



ACUTE ALBUMINURIA. 345 

In some cases, especially where the urine is muco- 
purulent or where the disease is a result of gonorrhoea, 
from 10 to 20 drops of the Balsam of Copaiba should 
be given three times a day. It may be given in capsules. 

In all cases where there is considerable pus in the 
urine — and its presence may be detected by obtaining 
a small amount of the sediment and adding an equal 
volume of Liquor Potassa to it, and causing them to 
thoroughly mix; if pus is present a viscid fluid is formed, 
which pours like thin jelly — the Sulphide of Calcium 
in doses of from 1-10 to 1-8 of a grain should be given 
every four hours. 

If the case is a protracted one the application of a 
Compound Tar Plaster over the region of the kidneys, 
requiring the patient to wear it as much as possible, 
should not be neglected. 

Where there are irregular chills, fevers and night- 
sweats, such remedies as Quinine, Aromatic Sulphuric 
Acid and the Oxide of Zinc should be given for their relief. 

If the fever assumes a continued or typhoid type, 
treat it as such. 

Keep the bowels open from the beginning of the 
attack. The most suitable remedy to use for this pur- 
pose is the Fl. Ext. of Carcara Sagrada. 

The diet should consist principally of milk. 

ACUTE ALBUMINURIA. 

ACUTE BRIGHT' S DISEASE OF THE KIDNEYS. 

This is ' •' an - acute inflammation of the epithelium 
of the uriniferous tubules; characterized by fever, scanty, 



346 THE PRACTICE OF MEDICINE. 

high-colored or smoky urine, dropsy, with more or less 
constant nervous phenomena, the result of acute 
uraemia. " — Hughes. 

The most common causes of. it are exposure to cold 
and damp; the eruptive fevers, especially scarlatina; 
diphtheria; the persistent use of such articles as tur- 
pentine, cantharides, phosphorus and ginger. 

Symptoms: "Occurring almost always after the erup- 
tive fevers, or exposure to cold, by which the surface is 
suddenly chilled; it commences generally with a well- 
defined chill, symptomatic fever follows, the pulse being 
hard and frequent, the skin hot, dry and constricted, 
the tongue coated white, the mouth dry, frequently 
nausea and vomiting, bowels constipated, pain in the 
back, and marked restlessness and nervous irritation. 
With these symptoms the patient complains of a sense 
of weight and constriction in the region of the kidneys, 
never, as is said, extending to or causing retraction of 
the testicles. The pain may be confined to one side, 
but one kidney being affected; or it may be equally in 
both sides. 

"With the occurrence of these symptoms the urine 
becomes scant, almost suppressed, and highly albuminous, 
of a reddish color, and occasionally bloody. Its specific 
gravity is almost always above that of healthy urine, and 
it gives an acid reaction. When allowed to rest, it 
deposits a filamentous substance, and when examined 
with a microscope, it presents blood-globules, mucus, 
epithelium, and in some cases, complete casts of the 



ACUTE ALBUMINURIA. 347 

urinary tubules. A dirty, white sediment is frequently 
deposited from the urine, not unlike mucus, and easily 
diffused by agitation. The urine is frequently passed 
with difficulty, and sometimes with pain, the calls to 
urinate being frequent and distressing. In the course of 
the second or third day dropsical symptoms make their 
appearance, most frequently as anasarca of the eyelids, 
face, and at last of the whole body. The skin at this 
time is hot, and does not pit except under firm pressure." 

"If properly treated, in a majority of cases, we find 
the symptoms are much mitigated in the first three or 
four days, and the disease terminates in recovery by the 
twelfth to the fifteenth day. In other cases, coma comes 
on by the second, third or fourth day, and the disease 
terminates fatally within the first week. Occasionally 
convulsions appear, and continue until the patient is 
exhausted. In other cases the disease seems to give 
way slowly until it reaches the chronic stage, in which 
it continues." — Scudder. 

Treatment: Control the fever with sedatives admin- 
istered according to indications. 

Administer a sufficient amount of Salts each day 
during the attack to keep the bowels open. 

Put the patient to bed, require him to remain there, 
and apply hot poultices, cloths wrung out of hot water, 
or dry cups, over the region of the kidneys. 

As soon as the more active symptoms have subsided 
20 drops of the Fl. Ext. of Asclepias Syriaca must be 
given three or four times a day. 



348. THE PRACTICE OF MEDICINE. 

When dropsical symptoms make their appearance, 
give the patient 3 or 4 drops of the Fl. Ext. of Apocynum 
Cannabinum four times a day. If this fails to relieve 
the dropsy, -J of a grain of Elaterium should be given 
every four hours, until free watery discharges from the 
bowels are produced, and thus repeated every one, two 
or three days as is needed and the patient is able to 
bear it. 

The following is* also very beneficial in these cases 
and is frequently more efficient than the Elaterium: 
Salts (Sulphate of Magnesia),. . .2 drachms, 

Bitartrate of Potassium, 1 drachm. 

Mix, dissolve in water and give at one dose, repeat- 
ing the same every four hours until copious watery dis- 
charges are produced from the bowels. This should also 
be repeated every day or so, as is necessary, when the 
patient is able to bear it. 

The first symptoms of uraemic poisoning should be 
recognized and an appropriate treatment for this con- 
dition adopted. 

When the general health is impaired, in the absence 
of fever, the following should be given: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make,. 6 ounces. 
Mix and give a teaspoonful three times a day before 
meals. 

The diet should consist of milk, teas and soups. 



CHRONIC ALBUMINURIA. 349 

CHRONIC ALBUMINURIA. 

CHRONIC BRIGHT 'S DISEASE. 

This is "a chronic inflammation of the cortical and 
tubular structure of the kidneys; characterized by albu- 
minous urine, dropsy, increasing anaemia, with attacks 
of acute uraemiae." 

"Causes: Rarely follows the acute form, but in 
ever so many cases the cause is unknown, and in the 
vast majority of cases it is primarily chronic or subacute; 
syphilis; chronic malaria; alcoholic excesses; chronic 
mercurialism ; lead poisoning; opium habit; protracted 
suppuration; phthisis; hepatic disorders; pregnancy; 
some undetermined nervous condition." — Hughes. 

Symptoms: "There are no marked symptoms in 
the early stage of the disease to arrest the attention of 
the patient or the physician. It is noticed that the 
patient is gradually losing flesh and strength, and has 
a characteristic appearance. The skin is dry and some- 
what harsh, and the patient does not perspire on active 
exertion as usual. The bowels are constipated, or in 
some cases irregular, diarrhoea alternating with constipa- 
tion; the appetite is variable, and there are more or less 
dyspeptic symptoms and headache. These symptoms 
and loss of strength at last become so marked as to cause 
the patient to consult a physician, it may be months, or 
sometimes two or three years from the commencement 
of the indisposition. On close questioning, we will find 
that the patient has a weakness of the back, probably 
a sense of fullness in the loins, and his attention has 



35o THE PRACTICE OF MEDICINE. 

been drawn to slight difficulty in passing the urine, and 
some alterations in its physical properties. In all such 
cases the careful physician will institute an examination 
to determine whether it is normal or not, and the char- 
acter of its constituents." 

"We determine the presence of albumen by the fact 
that it coagulates on the application of heat, and the 
addition of a small quantity of Nitric Acid, and though 
other material might be thrown down by heat or acid, 
yet none other by both. If we desire to be accurate, a 
small portion of urine should be placed in a small test- 
tube, and heated over a spirit-lamp; but if this is not 
convenient, a common iron spoon may be filled half-full, 
and heated over a common lamp or candle. Dr. Bird 
recommends that the extreme end of the bowl be placed 
over the flame, and in this way the thin layer of urine 
near the end of the spoon soon boils, and the white striae 
of the coagulated albumen gradually diffuses itself through 
the cooler liquid; in this way we can detect a very small 
quantity of this substance. The addition of a drop of 
Nitric Acid to albuminous urine immediately produces 
a copious coagulation of albumen. If but a small quan- 
tity is present, the opacity will disappear on agitation, 
but may be reproduced by the addition of a second 
drop. Both these tests should be employed, for, as 
before remarked, we may be deceived by one, but can 
not very easily with the two." 

"As the disease progresses the patient becomes very 
feeble and cachectic, and frequently dropsical. The 



CHRONIC ALBUMINURIA. 351 

appetite is poor, digestion feeble; the circulation weak; 
there is great emaciation; hectic fever appears in the 
evening, followed by night-sweats; the patient dying 
of gradual marasmus, or some other affection that is 
set up owing to the enfeebled condition of the system; 
or uraemia occurs, and carries the patient off in a very 
short time. Occasionally, in the later stages, the urine 
is scanty and but slightly albuminous, so there is some 
difficulty in determining the cause of the constitutional 
disturbance. " — Scudder. 

Treatment: The disease is incurable, therefore, all 
that can be done is to prevent as much as possible the 
progress of the disease, treating the complications as they 
arise and palliate the patient's suffering. 

Authorities very generally recommend a milk diet, 
or at most a very small amount of lean meat, fruits and 
vegetables, but the writer believes that the patient should 
be allowed to select his own diet, instructing him to care- 
fully avoid all articles that he finds to disagree with him 
in the least; however, intoxicating drinks of all kinds 
must be positively prohibited. 

Whenever fever is present, it should be controlled 
in this, as well as in any other disease, with sedatives 
administered according to indications. 

Where the urine is alkaline, 10 drops of Dilute Nitric 
Acid, largely diluted with water, should be given three 
or four times a day; or if the urine is acid, a sufficient 
amount of Bicarbonate of Soda should be added to a 



352 THE PRACTICE OF MEDICINE. 

glass of water until the taste becomes evident, and the 
solution used as a drink. 

Where there is scantiness of urine, from 20 to 30 
drops of the FL Ext. of Asclepias Syriaca, or 30 drops 
of the FL Ext. Chimaphila should be given four times 
a day. 

Instead of a scantiness of urine there is frequently 
an excessive flow. In these cases, the following should 
be given: 

FL Ext. of Ergot, 1 ounce, 

FL Ext. of Rhus Aromatica, 1 ounce. 

Mix and give a teaspoonful, in a sup of water, three 
or four times a day. 

If the bowels are constipated, they should be well 
regulated with Cascara Sagrada. 

The entire body should be sponged each" day with 
warm water, and in drying considerable friction should 
be used. 

Counter-irritation over the region of the kidneys is 
very important, and for this purpose nothing answers 
better than the Compound Tar Plaster. It should be 
worn intermittingly, as long each time as the patient can 
bear it. 

Where the patient is feeble or emaciated the follow- 
ing should be given: 

FL Ext. of Nux Vomica, 3 drachms, 

FL Ext. of Hydrastis Can., 1 ounce, 

FL Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make,. 6 ounces. 



CHRONIC ALBUMINURIA. 353 

Mix and give a teaspoonful three times a day before 
meals. 

If there are any symptoms of dropsy, 4 or 5 drops of 
the Fl. Ext. of Apocynum Cannabinum should be given 
four times a day. Where this fails to remove the drop- 
sical condition, £ of a grain of Elaterium should be given 
every four hours until free watery discharges from the 
bowels are produced, and thus repeated every one, two or 
three days as is needed and the patient is able to bear it. 

The following is also very beneficial in these cases 
and is frequently more efficient than the Elaterium: 

Salts (Sulphate of Magnesia), 2 drachms, 

Bitartrate of Potassium, 1 drachm. 

Mix, dissolve in a half-glass of water and give at one 
dose, repeating the same every four hours until copious 
watery discharges are produced from the bowels. This 
should also be repeated every day or so, as is needed, 
when the patient is able to bear it. 

Where there is great swelling of the feet and legs, a 
number of very small incisions may be made in them 
for the purpose of allowing the accumulated fluid to 
escape; or if the abdomen is greatly distended, tapping 
will have to be resorted to for the purpose of preventing 
suffocation. 

Should hectic fever and night-sweats occur, such 
remedies as Quinine, Aromatic Sulphuric Acid, Oxide 
of Zinc and cold Sage Tea may be given with a view of 
controlling them. 

Sexual intercourse must positively be prohibited. 



354 THE PRACTICE OF MEDICINE. 

DIABETES INSIPIDUS. 

This is an affection the pathology of which is not very 
well understood; characterized by continued thirst and 
the habitual discharge of a large quantity of pale urine, 
containing neither albumen nor sugar. It is more com- 
mon among children and young adults than older persons, 
and males are more subject to it than females. 

The causes of it are obscure, but it is thought to result 
from blows on the head, diseases of the brain or nervous 
system, exposure to cold, drinking freely of cold fluids 
when heated, intemperance, etc. It may be hereditary. 

Symptoms: An attack may begin suddenly or grad- 
ually, though the first symptom that attracts attention 
is a frequent desire to urinate, the urine being very clear 
and voided in large quantities, the amount varying from 
one to four or five gallons during each twenty-four hours. 
Its specific gravity is low, generally ranging from i.ooi 
to 1.007. Albumen and sugar are absent. 

The appetite is generally voracious; there is great 
thirst; the skin is dry and harsh, and the bowels are 
constipated. Unless relief is obtained, there is, sooner 
or later, great loss of flesh and strength. Diabetes 
insipidus may be mistaken for diabetes mellitus; in the 
latter there is sugar in the urine, while in the former it 
is entirely absent. 

Treatment: Regulate the bowels with the Fl. Ext. 
of Cascara Sagrada administered before each regular 
meal; and with a view of diminishing the quantity of 
urine, the following should be given: 



DIABETES MELLITUS. 355 

Fl. Ext. of Belladonna, § drachm, 

Fl. Ext. of Ergot, 1 ounce, 

FL Ext. of Rhus Aromatica, 1 ounce. 

Mix and give a teaspoonful four times a day; and, 
at the same time, give the following: 

Sulphate of Strychnine, ij grains, 

Hydrochloric Acid, 6 drops, 

Water, 8 ounces. 

Mix and give a teaspoonful before each regular meal. 

Fluids must be avoided as much as possible. 

DIABETES MELLITUS. 

This, as the preceding form, is an affection, the 
pathology of which is not very well understood; char- 
acterized by the constant presence of grape-sugar in 
the urine, an increased urinary discharge, thirst, and 
loss of flesh. All persons are subject to it, though it is 
more common in males than in females, and it occurs 
most frequently between the ages of twenty-five and 
fifty years. 

The causes of it are obscure, but it is thought to be 
caused by diseases of the nervous system, the liver or 
kidneys; the excessive use of malt liquors, saccharine 
food, and sexual excesses. It is often hereditary. 

Symptoms: An attack usually comes on gradually, 
the first symptoms that attract attention being an exces- 
sive discharge of urine and the loss of flesh and strength, 
the appetite remaining unimpaired. 

The amount of urine voided in each twenty-four 
hours varies from four to forty pints, of a specific gravity 



356 THE PRACTICE OF MEDICINE. 

ranging from 1.030 to 1.050, and contains a large amount 
of grape-sugar, which may be detected by various meth- 
ods, the following being the one most commonly used: 

Moore's Test: Add to a small amount of the sus- 
pected urine about half its bulk of pure Liquor Potassa, 
then boil it gently for a few minutes; if sugar is present 
the liquid assumes an orange-brown, or bistre tint. 
The subsequent addition of an acid generally causes the 
evolution of an odor of boiling molasses. 

As the disease advances the patient becomes very 
feeble and thin in flesh, so much so that he is confined to 
his room the greater part of the time. The skin is harsh 
and dry and the bowels are constipated. Usually thirst 
is almost constant and the patient drinks large quantities 
of fluids. 

Finally, in the latter stages of the disease, there are 
evening fevers, and night-sweats, the thirst continuing, 
but the appetite much impaired. In some cases, pul- 
monary tuberculosis sets in and runs its course very 
rapidly; in others, there is colliquative diarrhoea, or the 
kidneys fail to perform their function and the patient 
dies of uraemia. 

Diabetes mellitus may be distinguished from diabetes 
insipidus by the presence of sugar in the urine in the 
former disease and its absence in the latter. 

Treatment: The treatment of diabetes mellitus is 
not attended with that degree of success that we might 
desire. The regulation of the diet is of the first impor- 
tance in the treatment. Articles containing sugar or 



DIABETES MELLITUS. 357 

starch, which is converted into sugar during digestion, 
must be prohibited or greatly restricted. The main diet 
should consist of animal products such as meats, eggs, 
butter, game, poultry and fish; however, such vegetables 
as cabbage, celery, lettuce, spinach, onions, tender green 
beans and tomatoes may be allowed. The free use of 
milk is generally beneficial, although, theoretically, it 
is contra-indicated. Tea and coffee may be allowed, and 
no benefit is derived by withholding water except excessive 
amounts. Saccharin may be used as a substitute for 
sugar in tea or coffee. 

The patient should wear flannel next to the body the 
entire year; take a warm bath at least" three times a 
week; and daily exercise in the open air should be 
taken when the weather is suitable. 

If the bowels are constipated they must be well regu- 
lated with the Fl. Ext. of Cascara Sagrada administered 
before each regular meal. 

The quantity of sugar in the urine, as well as the 
quantity of urine, may be diminished with the fol- 
lowing : 

FL Ext. of Belladonna, \ drachm, 

Fl. Ext. of Ergot, 1 ounce, 

Fl. Ext. of Rhus Aromatica,. 1 ounce. 

Mix and give a teaspoonful four times a day; and 

if the patient is feeble, emaciated, give the following at 

the same time: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 



358 THE PRACTICE OF MEDICINE. 

Fl. Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make,. 6 ounces. 

Mix and give a teaspoonful three times a day before 
meals. 

If the patient is afflicted with boils, or a carbuncle, 
from the 1-10 to the § of a grain of the Sulphide of Cal- 
cium should be given every four hours. 

Whiskey, when actually demanded to support the 
strength, may be used in small amounts. 

Diarrhoea, when present, may be controlled in this 
as in any other disease. See Uraemia, and also Con- 
sumption. 

RENAL CALCULI. 
gravel; renal colic. 

Renal calculi or stones are concretions formed from 
constituents of the urine either in the substance of the 
kidneys or in their pelvis. When these concretions are 
very small (sand) the condition is known as gravel. 

Their cause is unknown. They occur in persons of 
all ages, and are more common in males than in females. 
Some families seem to be particularly predisposed to 
them. 

Symptoms: Stones may remain in the kidneys a 
long time and produce no appreciable symptoms. Again, 
they may cause renal hemorrhage, congestion or inflam- 
mation, terminating in abscess. 

When one of these concretions passes from the pelvis 
of the kidney into the ureter, a deep-seated, sharp, cutting, 
agonizing pain is felt in the region of the ureters, extend- 



RENAL CALCULI. 359 

ing to the corresponding groin, testicle, penis, and thigh, 
with retraction of the testicle. At this time, the face is 
pale and the features pinched; the surface is cold and 
damp and the pulse weak. At times the pain is so severe 
that the patient faints, has a general convulsion, or 
passes into a stupor or unconsciousness. 

There is a frequent desire to urinate, attended by 
burning pain, but only a few drops of urine pass and 
that is dark and often bloody. Where both ureters are 
obstructed it may be that no urine at all will be passed, 
and uraemic symptoms are very liable to arise. 

The stone moves slowly towards the bladder and 
finally passes into it, when, the pain ceases suddenly, 
and there is usually the passage of more or less bloody 
urine, with which the stone may be discharged. When 
these concretions are very small, like sand, they may be 
passed with very little pain. 

An attack lasts from an hour or so to several days. 
Persons, who have had one attack, are very liable to have 
another one. 

Treatment: The first thing that demands our atten- 
tion in the treatment of renal colic is the relief of pain ; 
and for this purpose a J of a grain of the Sulphate of 
Morphine should be given every hour or so, preferably 
hypodermically, as the urgency of the case demands, 
being careful, however, not to introduce a sufficient quan- 
tity of it into the system at one time to act as a poison. 

Chloroform is also a very useful remedy in these 
cases. It may be given in 20 to 30-drop doses, largely 



360 - THE PRACTICE OF MEDICINE. 

diluted with water, every twenty or thirty minutes until 
relief is obtained; or where the pain is exceedingly severe 
it may be very cautiously administered by inhalation, 
continuing its effects until the stone passes into the 
bladder. 

The action of these remedies may be aided by a hot 
sitz-bath, or the application of hot poultices, or dry cups 
over the region of the kidneys. 

For the purpose of controlling hemorrhage the fol- 
lowing is very efficient: 

Fl. Ext. of Ergot, i ounce, 

Fl. Ext. of Rhus Aromatica, i ounce. 

Mix and give a half- teaspoon ful every three or four 
hours until the hemorrhage is checked. 

As soon as the passage of the stone is effected, with 
a view of preventing the formation of another one, the 
Citrate of Lithium should be given in 5 -grain doses in 
tablet form three or four times a day. From 30 to 60- 
drop doses of the Fl. Ext. of Hydrangea three or four 
times a day is also efficient in these cases. 

Where the stone in the kidneys is too large to pass 
through the ureters the only hope of relief is by means 
of surgery. 

UREMIA. 

UREMIC POISONING. 

This is a group of nervous symptoms resulting from 
an abnormal accumulation of the constituents of the 
urine in the blood. 



UREMIA. 361 

The condition may be developed during tne course 
of any disease in which suppression of urine occurs, but 
it is most frequently seen in nephritis, pyelitis, renal 
colic, Bright's disease, the puerperal state and after sur- 
gical operations upon the bladder, urethra, kidneys or 
womb. Malaria is also probably responsible for it in 
many instances. 

Symptoms: An attack is usually preceded by scanti- 
ness or suppression of urine; although, in some cases, 
during, or immediately prior to its development the 
urinary flow may be considerably augmented. 

The symptoms, when well marked, are headache, 
vertigo, dimness of vision, deafness, drowsiness, and 
vomiting, frequently preceded or followed by convulsions, 
and then a deep sleep (coma) from which the patient 
may never be aroused. 

There is usually more or less fever, and it sometimes 
runs quite high. The fever aids us in distinguishing 
uraemic coma from Opium poisoning, in which the tem- 
perature is below normal. 

Treatment: Control the fever with sedatives admin- 
istered according to indications, in this as in any other 
disease. Give a large dose of Salts every three hours until 
copious watery discharges are produced from the bowels. 
Administer a vapor bath; and if convulsions are present, 
control them with J-grain doses of the Sulphate of Mor- 
phine, administered every hour or so, preferably hypo- 
dermically, as the urgency of the case demands. 



362 THE PRACTICE OF MEDICINE. 

If possible, restore the action of the kidneys. For 
this purpose give the following: 

Acetate of Potash, 5 drachms, 

Water, 2 ounces. 

Mix and give a teaspoonful every three hours. The 
Fl. Ext. of Buchu in from 30 to 60-drop doses is also a 
valuable remedy in these cases. 

If the attack results from malaria give Quinine as 
is recommended in remittent fever. 

HEMATURIA. 

HEMORRHAGES FROM THE URINARY PASSAGES. 

Hemorrhage may occur from the kidneys, the ureters, 
the bladder, or the urethra. 

The most common causes of it are injuries, especially 
falls or blows upon the loins, inflammation, irritating 
drugs, ulcers, and the presence of stones in the kidneys, 
or their passage through the ureters. 

Symptoms: When the hemorrhage is from the kid- 
neys, the patient complains of more or less pain and full- 
ness in the region of these organs, and the urine, when 
discharged, is thoroughly mixed with the blood. 

When the hemorrhage is from the ureters there are 
paroxysms of colicky pain similar to those caused by 
the passage of a renal calculus; however, not so severe. 

When the hemorrhage is from the bladder, there is 
pain in this organ, with more or less difficulty and pain 
in discharging the urine. There are only streaks of 
blood in the urine and these appear at the close of urina- 
tion, 



ACUTE CYSTITIS. 363 

When the hemorrhage is from the urethra, there is a 
continual dripping or oozing of blood from the penis. 

Treatment: Put the patient to bed, require him 
to remain quiet and administer the following: 

Fl. Ext. of Ergot, 1 ounce, 

Fl. Ext. of Rhus Aromatica, 1 ounce. 

Mix and give a teaspoonful, in water, every three or 
four hours. Should this fail to check the hemorrhage, 
from 10 to 15 drops of the Oil of Erigeron should be 
given every four hours. 

If the hemorrhage is from the bladder, it may be nec- 
essary to apply remedies to the inside of the bladder; 
though, a competent physician will have to be called to 
attend to this. 

ACUTE CYSTITIS. 

ACUTE INFLAMMATION OF THE BLADDER. 

This is an acute inflammation of the mucous mem- 
brane of the bladder; characterized by fever, pain in 
the region of the bladder, a frequent desire to urinate, 
vesical tenesmus, and a burning or scalding sensation 
in the urethra. 

The most common causes of it are exposure to cold 
and damp; external injuries over the region of the blad- 
der; a foreign substance, as a stone, in the bladder; 
urethritis, especially gonorrhoeal; stricture of the urethra; 
over-doses, or the continued use of irritating diuretics, 
and over-distention of the bladder by the long retention 
of urine. It is sometimes secondary to nephritis, fevers 
or diphtheria. 



364 THE PRACTICE OF MEDICINE. 

Symptoms: An attack usually commences with pain 
in the region of the bladder followed by more or less 
fever. As the disease advances, there is an almost con- 
stant desire to urinate, attended by a burning, or scald- 
ing sensation in the urethra; and, when the urine is 
passed, there is a disposition to strain, or bear down, 
which greatly increases the patient's suffering. The 
urine, in some cases, is voided drop by drop, and it is 
not infrequently streaked with blood. Sometimes patients 
are unable to void the urine. In these cases there is 
distention of the bladder, and this produces great dis- 
tress. The pain may extend to the penis, the perinaeum 
and other parts in the region of the bladder. 

In unfavorable cases, the fever may assume a contin- 
ued or typhoid type. In these cases, there is frequently 
delirium or stupor, and sometimes convulsions. The 
patient's countenance becomes pale and death-like, and 
he shortly expires. 

Treatment: Control the fever throughout the attack 
with sedatives administered according to indications. 
Keep the bowels moderately open. To accomplish this 
give Salts as is necessary. 

The Fl. Ext. of Corn Silk should be given in tea- 
spoonful doses every four hours. It is soothing to the 
bladder and is one of our very best remedies in these 
cases. 

The following is also useful in these cases: 

Acetate of Potash, 5 drachms, 

Water, 2 ounces. 



CHRONIC CYSTITIS. 365 

Mix and give a teaspoonful every four hours. 

Hot poultices should be applied over the region of 
the bladder and to the perinaeum, changing them suffi- 
ciently often to prevent their becoming cool. The hot 
sitz-bath may also be frequently used and it affords 
marked relief in a majority of cases. 

When the pain is severe, an enema of Laudanum 
and warm water may be given. The proper amount 
of the Laudanum is 30 drops to 2 ounces of water. 

After the more acute symptoms have subsided, excel- 
lent results follow the use of the following: 

Boracic Acid, 1 drachm, 

Water, 1 pint. 

Mix and use as a wash for the bladder by means of 
a catheter. In using this wash a soft rubber catheter 
may be attached to a small funnel, which, after the cathe- 
ter is introduced, should be raised above the patient's 
body and the fluid allowed to enter the bladder by the 
force of gravitation. 

The patient should be confined to bed during the 
attack and restricted to a light diet. 

CHRONIC CYSTITIS. 

CHRONIC INFLAMMATION OF THE BLADDER. 

This is a chronic inflammation of the mucous mem- 
brane of the bladder; characterized by pain in the 
region of the bladder, a frequent desire to urinate, with 
more or less mucus and pus in the urine. 

It may result from a continuation, or the frequent 
repetition, of the causes that produce the acute form of 



366 THE PRACTICE OF MEDICINE. 

the disease, and it may also follow an acute attack. 

Symptoms: These are the same as the symptoms 
of acute cystitis, however, they are not so severe and 
there is usually the absence of fever, and the urine is most 
frequently alkaline and contains more or less mucus, or 
mucus and pus, and on standing it deposits a sediment. 

The bladder is sometimes ulcerated; in these cases 
the urine is usually streaked with blood. As the disease 
progresses the bowels become constipated; the appetite 
impaired, and the patient gradually fails in flesh and 
strength. 

Treatment: Regulate the bowels with the Fl. Ext. 
of Cascara Sagrada. administered before each regular 
meal and give a teaspoonful of the Fl. Ext. of .Corn Silk 
four times a day. 

If the urine is alkaline, give 10 drops of Dilute Nitric 
Acid, largely diluted with water, three or four times a 
day. Instead of this from 5 to 10 grains of Benzoic 
Acid may be used two or three times a day. 

If the urine is acid, the following should be given: 

Acetate of Potash, 5 drachms, 

Water, to make, 2 ounces. 

Mix and give a teaspoonful three or four times a day. 

It should be- remembered that acids change the color 
of blue Litmus to red, and alkalies change the red paper 
to blue. 

If these means fail to effect a cure the bladder should 
be washed out once a day with one of the following 
remedies : 






CHRONIC CYSTITIS. 367 

Boracic Acid, 40 grams, 

Water (warm), 4 ounces. 

Mix and convey into the bladder, instructing the 
patient to retain it as long as possible, or: 

Nitrate of Silver, 1 grain, 

Water (warm), 4 ounces. 

Mix and use as the preceding, or: 

Bichloride of Mercury, \ grain, 

Water (warm), 12 ounces. 

Mix and use as the preceding; however, do not use 
more than four ounces of it at once. 

These washes may be introduced into the bladder 
by means of a soft rubber-catheter attached to a small 
funnel. After the catheter is introduced the funnel 
should be raised above the patient's body, when, the fluid 
will enter the bladder by the force of gravitation. 

The late Dr. King recommends Elaterium in these 
cases. A tincture of it is made by adding one drachm 
of it to a pint of Alcohol. He says: "I have used this 
remedy since 1849, and with invariable success. In the 
more severe cases, I have usually commenced by giving 
half a fluid drachm of the Tr. of Elaterium, one, two, 
or three times a day, until it acted upon the bowels; and 
afterwards continued its use in doses of from 5 to 10 
drops, gradually increasing the dose as it could be borne. 
Great relief has always followed in these cases, as soon 
as the purgative effect came on from the first large doses, 
and that, too, in cases where other purgatives had been 
frequently taken without any relief whatever. In less 



368 THE PRACTICE OF MEDICINE. 

severe cases I commence with 6 or 8 drops three times 
a day, gradually increasing it as can be borne, and being 
very careful to avoid giving it in doses to act on the 
bowels. This action I have only deemed necessary at 
the commencement of treatment in the more severe and 
obstinate cases. A great difference will be found among 
different persons as to the doses they can bear, therefore, 
some care should be used on commencing the treatment." 

VESICAL CALCULUS. 

STONE IN THE BLADDER. 

By this is meant the presence of hardened concretions 
in the bladder, formed from materials in urine. These 
stones increase in size until they sometimes become enor- 
mously large. 

The cause of their formation is not well understood. 

Symptoms: When there is a sense of weight in the 
perinaeum, and, sometimes, of a body's rolling when the 
patient changes his position; a frequent desire to urinate, 
and a sudden stoppage to the flow of urine; pain and 
a sense of burning when the bladder is empty, becoming 
easier as this organ is filled, the presence of a calculus 
may be suspected. This, however, can not be positively 
known without the introduction of a sound into the 
bladder, when, if a stone be present, the characteristic 
click is produced by the metallic instrument's coming 
in contact with the stone. 

Treatment: The stone, when small, may be removed 
by crushing it and then washing out the fragments; or 
by cutting into the bladder and removing it entirely. In 



ENURESIS. 369 

females, where the stone is not too large, the urethra 
may be dilated sufficiently for its removal through this 
outlet. Of course, no one but a competent surgeon 
should be entrusted with either operation. 

ENURESIS. 

INCONTINENCE OF URINE. 

Incontinence of urine is an involuntary escape of 
this fluid from the bladder. There are two forms of the 
disease. In one, the urine is discharged in small amounts, 
especially when the patient is laughing, sneezing or 
coughing. The other form of the disease is seen princi- 
pally in children and is characterized by nocturnal incon- 
tinence, or "wetting the bed." 

It may result from irritability or paralysis of the blad- 
der; enlargement of the prostate gland; injury to the 
spinal nerves; mechanical pressure as from tumors, 
stone in the bladder, pregnancy, etc. 

Treatment: In many of these cases the following 
affords prompt relief: 

Fl. Ext. of Belladonna, \ drachm, 

Fl. Ext. of Ergot, 1 ounce, 

Fl. Ext. of Rhus Aromatica, 1 ounce. 

Mix and give a teaspoonful three or four times a day. 
When it is dependent upon irritation of the bladder 
the treatment recommended for chronic cystitis should 
be given. 

When it is a result of paralysis of the bladder, give 
the following: 



370 THE PRACTICE OF MEDICINE. 

Fl. Ext. of Nux Vomica, 3 drachms, 

FL Ext. of Hydrastis Can., 1 ounce, 

Aromatic Elixir, to make, 6 ounces. 

Mix, give a teaspoonful three times a day, before meals. 
When it arises from other diseases these will have 
to be overcome before a cure can be expected. 

Treatment avails nothing in incontinence of urine 
.arising from pregnancy. 

ISCHURIA. 

RETENTION OF URINE. 

When the urine is excreted by the kidneys and con- 
veyed to the bladder and retained in this organ, the con- 
dition is known as ischuria, or retention of urine. For 
information of the general reader we will just state that 
when the urine is voided with difficulty the condition 
is called dysuria; and when it is discharged drop by 
drop, and attended by a severe, burning or scalding 
pain, the condition is called strangury. 

It may be the result of an impacted calculus; par- 
alysis of the bladder; inflammation of the neck of the 
bladder; spasms of the muscles surrounding the urethra; 
enlargement of the prostate gland; stricture of the 
urethra; and the effects of over-doses of such remedies 
as Turpentine and Cantharides. It may also occur when 
the urine is voluntarily retained a considerable length 
of timi after there has been a natural desire to void it. 

Symptoms: There is a constant desire to void the 
urine with an inability to do so, accompanied by a feeling 
of fullness and pain in the region of the bladder; and, 



PHIMOSIS. 371 

when the bladder is very much distended it may be felt 
through the abdominal wall above the pubic bone. If 
relief is not obtained the suffering increases hour by 
hour; and finally, sooner or later, the bladder ruptures, 
resulting in general peritonitis and death. 

Treatment: The patient may be given a hot sitz- 
bath lasting for twenty or thirty minutes and then placed 
in bed and cloths wrung out of hot water applied to the 
perinaeum and over the region of the bladder. Should 
these means fail, the bladder must be emptied by means 
of a soft, rubber-catheter. 

When the retention is a result of paralysis, stricture 
or enlargement of the prostate gland, the catheter must 
be used several times a day, as is required, until the 
cause of the trouble is removed. 

When the condition is the result of inflammation or 
irritation, teaspoonful doses of the Fl. Ext. of Corn Silk 
should be given three or four times a day. 

DISEASES OF THE MALE ORGANS OF GEN- 
ERATION. 
PHIMOSIS. 

This is an unnatural narrowness of the preputial ori- 
fice so that retraction of the prepuce behind the corona 
glandis is either difficult or impossible. The preputial 
orifice is sometimes so small that the stream of urine is 
greatly diminished. 

In a great majority of cases the deformity exists from 
birth. In other cases, it results from inflammation 
caused by injuries, venereal diseases, etc. 



372 THE PRACTICE OF MEDICINE. 

Treatment: When it is a result of inflammation, 
the foreskin usually assumes its natural condition when 
the inflammation subsides. 

In congenital phimosis the only remedy is an opera- 
tion commonly known as circumcision. Alter the fore- 
skin is removed, the outer skin and mucous lining should 
be carefully stitched together. 

PARAPHIMOSIS. 

By paraphimosis is meant a condition in which a 
narrow prepuce is retracted over the glans penis. This 
condition is occasionally met with in boys under ten years 
of age, who have, through curiosity, pushed the foreskin 
back behind the corona glandis and have been unable 
to return it. 'The foreskin, thus retracted, forms a con- 
striction, which interferes with the circulation of blood, 
thus producing intense swelling, inflammation and finally 
gangrene. 

Treatment: The foreskin must be returned to its 
natural position. To accomplish this anoint the parts 
thoroughly with vaseline or common lard, and then 
grasp the penis on each side between the index and 
middle fingers of each hand. Now, by pressing the head 
of the penis with the thumbs, and pulling up on the 
foreskin with the fingers, the difficulty may be usually 
overcome. Should this fail, after two or three attempts, 
the constriction will have to be relieved by means of a 
curved bistoury. 



BALANITIS. 373 

STRICTURE OF THE URETHRA. 

This is a contracted, or narrowed condition of the 
canal through which the urine is discharged from the 
bladder. 

It may result from inflammation, or the forcible and 
improper introduction of foreign bodies, such as cathe- 
ters or bougies, into the urethra, but it is more com- 
monly a result of gonorrhoea, especially neglected or 
badly treated cases. 

Symptoms: There is usually a gleety discharge from 
the urethra, accompanied by a frequent desire to urinate; 
difficulty in starting the flow of urine; a diminution in 
the size and force of the stream, which is usually twisted 
or divided. These symptoms become more marked as 
the disease advances, and finally a pain is felt in the 
neck of the bladder, in the glans penis and in the per- 
inaeum. 

Treatment: There are three methods of treatment; 
gradual dilatation with the sound, cutting the stricture, 
and its removal by means of electricity. The first named 
is probably the best method. If this method is used, 
commence with a small sound, gradually changing to a 
larger size until the normal size of the urethra is reached, 
when, after using this sound for a few weeks, every third 
day, it should only be used once or twice a month. 

BALANITIS. 

Balanitis is an inflammation of the mucous membrane 
lining the foreskin and covering the glans penis. 



374 THE PRACTICE OF MEDICINE. 

It may be caused by uncleanliness, gonorrhoea or 
irritation of the parts from any cause. 

Symptoms: The parts become tender, red and swol 
len, and there is a free discharge of mucus, or muco-pus 
thrown off from the surface. 

Treatment: Keep the parts clean. The free use 
of warm water will accomplish this. The following is 
usually all that is required in these cases: 

Sulphate of Zinc, 32 grains, 

Sulphate of Morphine, 16 grains, 

Rose-Water, 8 ounces. 

Mix and bathe the parts freely with it every two or 
three hours; or: 

Bichloride of Mercury, 4 grains, 

Water, 8 ounces. 

Mix and use as the preceding. 

ORCHITIS. 
inflammation of the testicles. 

Orchitis is an inflammation of one or both testicles 
either of an acute or chronic character. 

It may be caused by exposure, or an injury, but it is 
more commonly a complication of mumps or gonorrhoea. 
The left testicle appears to be more subject to inflam 
mation than the right one. 

Symptoms: These are usually fever, severe pain and 
tenderness with great swelling and constipation of the 
bowels. 

Treatment: Control the fever with sedatives admin- 
istered according to indications, adding Phytolacca, thus 



VARICOCELE. 375 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Phytolacca Decandra,. .12 drops, 

Water, 18 teaspoonfuls. 

Mix and give a teaspoonful every hour and a half 
while there is fever. If the stomach is irritated, of 
course, Aconite should be used instead of the Vera- 
trum, and if indicated Gelsemium or Belladonna should 
also be given. 

Require the patient to remain quiet in bed and sup- 
port the testes with a small pillow between the thighs 
and use the following: 

Muriate of Ammonia, 2 drachms, 

Fl. Ext. of Phytolacca Decandra, 1 ounce, 

Alcohol, 1 ounce, 

Water, sufficient to make, 8 ounces. 

Mix and apply by means of cloths saturated with the 
mixture, keeping them wet. 

If the bowels are constipated give Salts or Seidlitz 

Powders when necessary, in order to keep them open. 

Where the pain is very severe it may be necessary 

to give I of a grain of the Sulphate of Morphine every 

two or three hours, for its relief. 

In chronic orchitis, adhesive straps should be applied 
around the testicle in such a way that uniform pressure 
is made on the testicle; and a suspensory bandage should 
be worn all the time. 

VARICOCELE. 

Varicocele is a varicose, or enlarged, condition of the 
spermatic veins. In well-marked cases, the veins appear 



37 THE PRACTICE OF MEDICINE. 

knotted, and feel very much like a bundle, or mass of 
common earth-worms. The left side is more frequently 
affected than the right side. Severe cases are apt to 
result in atrophy, or wasting of the testicle. 

Its causes are rather obscure, though it probably 
results from strains, overexcitement of the sexual organs, 
constipation, etc. 

Treatment: A suspensory bandage should be worn 
until an opportunity is had to consult a competent sur- 
geon, who may perform an operation that will effect a 
radical cure. 

IMPOTENCE. 

By impotence is meant an inability to perform the 
act of coition; and this inability may be transient or per- 
manent. 

It may arise' from exhaustion of the genito-spinal 
center, and is then known as atonic impotence. The 
most common cause of this exhaustion is morbid sensi- 
tiveness and inflammation of the prostatic urethra. It 
may arise from some brain disease, which destroys the 
normal activity of the center (psychical impotence). It 
may be due to various diseases, acute or chronic, or be 
symptomatic of the administration of certain drugs or 
beverages. 

Symptoms: "It varies greatly in kind and degree 
in different cases. In one there is a total want of power 
to effect an erection. In another the erection is so brief 
that the act can not be completed. In a third, the sem- 
inal fluid is ejected before the erection is complete. In 



IMPOTENCE. 377 

a fourth, the ordinary excitement of copulation is not 
sufficient to effect the ejection. In the fifth, intercourse 
is not pleasurable, and gives satisfaction to neither party. 
In all, the patient feels badly, is nervous, disgusted with 
himself, and prays anxiously for relief." — Scudder. 

Treatment: Correct any impairment of the general 
health that may be present; prohibit sexual intercourse 
entirely; require the patient to take moderate exercise 
in the open air each day; instruct him to associate with 
pleasant company; and to get his mind off of his malady 
entirely. Assure him that his condition will not terminate 
fatally; neither will he lose his mind; and that, ten 
chances to one, he will soon be well and strong. 

If he is nervous and debilitated give the following: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Damiana,. 3 ounces, 

Aromatic Elixir, to make, 6 ounces. 

Mix and give a teaspoonful before each regular meal. 

Phosphorus is also a valuable remedy in these cases. 
It may be given in from 1-50 to 1-100 of a grain, in pill- 
form, or in the form of Phosphide of Zinc in from 1-20 
to 1 -10 of a grain three times a day after meals. 

Yohimbin is also useful in these cases.' It may be 
given in doses of from 1-30 to 1-10 of a grain three times 
a day after meals. 

Where there is nervous debility, in addition to the 
foregoing treatment, a current of electricity should be 
passed through the brain and spinal cord once a day. 



378 THE PRACTICE OF MEDICINE. 

The positive pole of the battery should be applied to the 
head and the negative, to the perinaeum. 

The diet should consist of such articles as fish, eggs, 
meats, oysters, milk, etc. 

SPERMATORRHEA. 

By spermatorrhoea is meant an unnatural loss of 
semen. This loss may occur at night, during lascivious 
dreams, or the drain may be gradual and occur in the 
day-time. In some, the flow follows micturition, or an 
evacuation of the bowels. An occasional emission occur- 
ring in a healthy, unmarried adult can not be considered 
unnatural, as the semen is being secreted continuously 
and must escape in some way; but when these emissions 
are frequent, or when there is a constant drain, it results 
in a condition of great mental and physical weakness. 

The principal causes of spermatorrhoea are self-abuse 
and excessive sexual intercourse. 

"Often the victim of self-pollution and involuntary 
seminal losses, has had his case made worse by the rep- 
resentations of those who issue pamphlets, circulars, and 
advertisements, in order to scare the ignorant and swindle 
the inexperienced and the credulous. The reader of such 
literature is frightened into the belief that he can not be 
saved from idiocy or lunacy; and being thus discour- 
aged, does not put forth the effort necessary to restora- 
tion." — Howe. 

Treatment : When the disease is a result of self- 
abuse, the patient must be impressed with the importance 
of abandoning the habit, as it is utterly impossible to 



SPERMATORRHOEA. 379 

effect a cure without this; or if it is a result of excessive 
sexual intercourse, total abstinence must be enjoined. 

The following answers an admirable purpose in these 
cases : 

Sulphate of Strychnine, 2 grains, 

Dilute Hydrochloric Acid,. . 1 drachm, 

Dilute Phosphoric Acid,. 2 ounces, 

Water, sufficient to make, 8 ounces. 

Mix and give a teaspoonful, in water, before each 
regular meal. In addition to this where there are las- 
civious dreams, with seminal emissions during the night 
10 grains of Lupulin, or 20 grains of the Bromide of 
Potash, may be given at bed-time. Lupulin, however, 
is the preferable " remedy. If the loss of semen occurs 
during an evacuation of the bowels, the Fl. Ext. of Gel- 
semium should be given in from 2 to 4-drop doses four 
times a day. 

A final cure may be very materially aided by the use 
of electricity. The sponge-electrode should be attached to 
the positive pole of the battery and applied to the perin- 
aeum, and the electrode attached to the negitive..pole, should 
be applied to the lumbar region, the epigastrium or pubes, 
for at least fifteen minutes daily. Where the attack is 
of long standing, the electric current should be mild at 
first. The patient must form regular habits; take daily 
exercise in the open air; and avoid the use of spirituous 
liquors. If these means fail to effect a cure, a No. 8 
bougie should be introduced in to the urethra twice daily. 
The instrument should be well oiled and then care- 



380 THE PRACTICE OF MEDICINE. 

fully carried the whole length of the urethra, includ- 
ing the prostatic portion of this canal. After the instru- 
ment is inserted, it should be left in place for five or ten 
minutes. The first few times the instrument is introduced 
it may occasion some pain, but this will pass away as the 
patient becomes accustomed to its use. 

MASTURBATION. 
self-abuse; self-pollution. 

By masturbation, or self-abuse, is meant an excite- 
ment of the genital organs by the hand. It is a vice 
indulged in, more or less by both sexes. The habit 
is occasionally met with in very young children, but it 
is more commonly commenced about the eighth or tenth 
year of age. In a majority of cases it is abandoned when 
patient arrives at maturer years. 

The results of it are a weakness of the reproductive 
organs, nervous diseases, impairment of the mind, sper- 
matorrhoea, varicocele, impotency, epilepsy, hysteria, 
insanity, and not infrequently suicide. 

Symptoms: These, at first, are only circumstantial. 
The patient is pale, has a downcast look, is unable to 
look another fairly in the face, and avoids company, 
especially strangers. If the general health is much 
impaired, we will find the appetite irregular, the bowels 
constipated, the tongue coated in the center, and the breath 
offensive. If the patient is a female, there is apt to be 
irregularity, or suppression of the menses. When the 
foregoing symptoms present themselves, a close watch 



GONORRHCEA. 381 

should be kept over the patient, to determine the correct- 
ness of our suspicion. 

Treatment: This consists, usually, of proper advice 
from parents or guardians. 

In boys, circumcision breaks the habit at once. 

GONORRHCEA. 

CLAPP. 

Gonorrhoea is a specific inflammation, primarily involv- 
ing the urethra of males and the vagina of females; char- 
acterized by pain, swelling of the mucous membrane and 
the formation of pus. In both males and females the 
inflammation may extend from the urethra into the bladder, 
ureters and even into the pelvis of the kidneys; and in 
the female, it not infrequently extends into the womb 
and on to the fallopian tubes and ovaries, setting up 
what is known as gonorrhbeal salpingitis and ovaritis and 
in rare instances even peritonitis. 

The disease is caused by the gonococcus of Neisser, 
a diplococcus occurring in groups of from ten to thirty, 
surrounded by a transparent mucus-like material. The 
germ is communicated by the parts coming in contact 
with pus containing them during sexual intercourse. Of 
course, the disease may be contracted in any manner 
that brings the gonorrhceal pus in contact with mucous 
surfaces, such as using the same vessel, privy, etc., that 
is used by one afflicted with the disease. 

An inflammation, very much resembling that of gonor- 
rhoea, may follow intercourse with a virtuous woman, 
during, or immediately after her monthly periods; or with 



382 THE PRACTICE OF MEDICINE. 

one afflicted with vaginitis or leucorrhcea, however, in this 
form of urethritis there is an absence of the gonococci. 

Symptoms : The disease usually makes its appearance 
in from two to five days after exposure. In the male, it 
commences with an uneasy, itching sensation in the end 
of the penis, just within the lips of the opening of the 
urethra. Soon after this a clear, whitish discharge appears, 
which shortly becomes thick and yellow. While urinating 
there is a burning sensation, which in some cases is 
extremely severe. In severe cases, the fore skin is inflamed 
and swollen, the parts presenting a reddened, angry 
appearance. 

After the inflammation subsides to some extent, there 
are frequently painful erections during the night. Some- 
times, when these erections occur, there is chordee, a con- 
dition in which the penis, instead of presenting a curvature 
upward and backward, is compelled to curve downward 
by the tumified and inextensible condition of the urethra 
and surrounding tissues. Occasionally there is tenderness 
with swelling of the inguinal glands, but suppuration is 
uncommon. In some cases the inflammation is so severe 
that it causes general febrile symptoms, which may 
last for a few days. 

In the female, the disease is not usually as painful 
as it is in the male, however, there is a purulent discharge 
from the vagina and a burning, or scalding sensation in 
the parts with more or less pain in the back; and when 
the inflammation extends to the urethra a burning or 
scalding sensation is felt when the urine is discharged. 



GONORRHCEA. 383 

Of course, a cystitis is set up when the disease extends 
to the bladder; and a nephritis when it extends to the 
kidneys. When it extends into the womb an endometritis 
with more or less pain and cramping is established. When 
the disease extends to the fallopian tubes and ovaries there 
is pain, tenderness and cramping in each iliac region. 

Treatment: During the first few days of an attack 
the patient should remain quiet and keep the bowels moder- 
ately open with Salts; and, the following wash should be 
used until the discharge becomes yellow: 

Sulphate of Morphine, 4 grains, 

Glycerine, 1 ounce, 

Rose-Water, sufficient to make, 6 ounces. 

Mix and inject a syringeful into the urethra everv two 
or three hours. 

As soon as the discharge becomes yellow, use the 
following instead of the foregoing: 

Sulphocarbolate of Zinc, 30 grains, 

Distilled- Water, 12 ounces. 

Mix and inject into the urethra every three hours. 
After injecting the first syringeful, which will wash out the 
urethra, immediately use another injection, which should 
be retained for two or three minutes. 

The following are some of the more efficient washes 
in hese cases: 

Permanganate of Potash, 3 grains, 

Distilled- Water 12 ounces. 

Mix and use as the preceding, or: 



384 THE PRACTICE OF MEDICINE. 

Sulphate of Zinc, 16 grains, 

Aqueous Hydrastis Can., 1 ounce, 

Distilled- Water, 7 ounces. 

Mix and use as the preceding. 

If none of these washes seem to control the inflamma- 
tion wash out the urethra thoroughly with the following, 
before using the medicated wash: 

Peroxide of Hydrogen, 3 ounces. 

Distilled-Water. ... 1 3 ounces. 

Mix and inject several syringefuls into the urethra, 
retaining each one for a half-minute, after which use the 
medicated wash. 

If the burning sensation during urination is severe, the 
following should be used: 

Acetate of Potash, 5 drachms, 

Water, sufficient to make, 2 ounces. 

Mix and give a teaspoonful every four hours. 
Where painful erections occur during the night, 20 
grains of the Bromide of Potash should be given just before 
retiring. If this fails to afford relief 1 grain of Opium may 
be given at bed-time. 

The proper syringe to use in the treatment of gonor- 
rhoea is a blunt conical pointed rubber one holding f of 
an ounce. 

In the female, during the height of the inflammatory 
action, the vagina should be thoroughly washed out several 
times a day with warm water. As soon as the inflamma- 
tion has subsided to some extent the following wash 
should be used: 



GLEET. 385 

Bichloride of Mercury, 7§ grains, 

Warm Water, 1 pint. 

Mix and inject into the vagina, with an ordinary house- 
hold syringe, several times a day after washing thoroughly 
with warm water. If the urethra is involved, the syringe 
and washes recommended for the male may be used. 

- If the bladder is involved the treatment recommended 
for cystitis should be used; and if the kidneys are involved 
the treatment recommended for nephritis may be given. 
If the cavity of the womb is involved its cavity should 
be washed out once or twice a day with the mercurial 
solution previously recommended. 

When the disease extends to the fallopian tubes and 
ovaries their removal offers the only hope of a cure. 

Great care must be exercised by those who are suffer- 
ing with gonorrhoea to prevent the introduction of any of 
the discharge into the eyes as it excites a very violent 
inflammation in these organs. 

All meats and highly seasoned articles of food as well 
as stimulants must be prohibited. Coition must also be 
prohibited as it is almost always followed by a re- 
lapse. 

GLEET. 

Gleet is a chronic inflammation of the urethra and 
rarely, if ever, occurs except as a result of gonorrhoea. In 
many cases its immediate cause is a stricture of the 
urethra, which see. 

Its only symptom of any importance, is a discharge 
of a clear, viscid fluid from the urethra. 



386 THE PRACTICE OF MEDICINE. 

Treament: This should be commenced by the 
administration of the following: 

Balsam of Copaiba, i ounce, 

Sweet Spirits of Nitre, i ounce, 

Oil of Santal, i ounce, 

Compound Tr. of Lavender, i ounce. 

Mix and give a teaspoonful three times a day before 
meals. 

The following should be used at the same time: 

Elixir of Vitriol, 32 drops, 

Distilled- Water, 4 ounces. 

Mix and use as an injection three or four times a day. 
If the foregoing fails to effect a cure the trouble is 
probably caused by a stricture, which see. 

SYPHILIS. 

POX. 

Syphilis, or pox, is a constitutional, hereditable, specific, 
infectious disease of three stages: Primary, Secondary 
and Tertiary. 

The nature of its virus is unknown; but it is communi- 
cable by sexual intercourse, and by the virus coming in 
contact with an abraded surface or a mucous membrane, 
such as the lips, tongue and nose. Secondary, or tertiary 
syphilis may be transmitted to offspring, and it frequently 
gives rise to abortion about the fourth or fifth month of 
pregnancy; sometimes, the child is born at full term, but 
with copper-colored blotches and ulcers in various parts 
of the body, as well as having other symptoms indicative 
of the taint; and it is not uncommon for the wife herself 



SYPHILIS. 387 

to become tainted with the secondary form of the disease 
when existing in the husband 

Primary Stage; Hard Chancre: From two to six 
weeks, rarely longer, after exposure a burning itching sen- 
sation is felt, and, upon examination, a small circular or 
oval-shaped pimple, filled with a transparent fluid, and 
surrounded by a slightly inflamed surface, is found, usually 
on the genital organs, these being the parts most frequently 
exposed to the virus. This pimple soon assumes a yel- 
lowish color, breaks and forms a cup-shaped ulcer, from 
which an infectious matter is discharged. The tissues 
immediately surrounding the ulcer and constituting its 
base and walls become hard, hence the name indurated 
or hard chancre. 

Bubo: This is an inflammation of the lymphatic 
glands of one or both groins, usually occurring after the 
local sore has existed for several days. It is caused by 
the absorption of the virus, and is believed by some, to be 
an intermediate condition between the primary sore and 
the secondary form of the disease. 

In some cases, the inflammation terminates in the 
formation of an abscess, which, after the pus is discharged, 
leaves an open ulcer; in other cases, it terminates in resolu- 
tion, the swelling gradually subsiding. 

Secondary or Constitutional Syphilis: Two forms 
of constitutional syphilis are recognized; secondary and 
tertiary. This form of the disease as previously stated 
results from the absorption of the syphilitic virus into the 
general system. Unless prevented by treatment, usually 



388 THE PRACTICE OF MEDICINE. 

in from six weeks to six months, sometimes longer, after 
the appearance of the primary sore, the secondary or 
constitutional symptoms make their appearance. These 
consist of a copper-colored eruption on the forehead, back, 
arms, legs, mouth and other parts of the body; the forma- 
tion of small ulcers in the mouth and throat, and not infre- 
quently more or less loss of the hair. 

The eruption may consist of a copper-colored rash, 
with slight itching; as distinct copper-colored pustules, 
which form deep ulcers with a pale greyish bottom; as 
dusky brown tumors, which break and form scabs, under 
which the skin is extensively ulcerated. 

Tertiary Syphilis: Generally, in the course of six 
or eight months, if not prevented by treatment, after the 
secondary form of the disease has made its appearance, 
severe pains are experienced in various parts of the body; 
lumps called nodes appear on the bones, and these finally 
ulcerate, causing decay and exfoliation. The bones most 
frequently affected are those of the shin, elbow and fore- 
head. Ulcers frequently form in the nose and destroy the 
surrounding tissues, so that the nasal passages and the 
mouth frequently form one cavity. Large, morbid growths 
may appear on various parts of the body. The brain and 
spinal cord are not infrequently involved producing insanity 
or paralysis. 

Treatment of Primary Syphilis: If the patient is 
seen before the chancre becomes an open sore, the penis 
should be thoroughly washed with green soap and water 
that has been previously boiled, and, then washed with a 



SYPHILIS. 389 

1 to 1000 solution of Bichloride of Mercury (about 7! 
grains to the pint). The sore should now be thickly 
covered with dry Iodoform and then covered with four or 
five. layers of Iodoform- Gauze about an inch square. Care- 
fully cover this with Bichloride- Gauze. Now apply a 
bandage or other dressing to hold all in place, being careful 
to leave the meatus exposed so that the urine can be dis- 
charged. In two or three days the outer dressing may 
be removed, and if the squares of gauze are adhered to 
the sore, do not remove them, but dress again with the 
Bichloride- Gauze as before and the sore will usually heal 
without pain, a severe sore or buboes. 

If the sore is already an open one, the parts should 
be thoroughly cleansed, as previously recommended, 
removing all pus from the sore with Peroxide of Hydrogen 
before washing with the Bichloride Solution. Dress as 
before. The patient should be supplied with the Per- 
oxide of Hydrogen, Bichloride Solution, Iodoform and 
Gauze and instructed to dress the sore every hour or so 
until the formation of pus is checked. Should this treat- 
ment fail to heal the sore, it should be carefully cleansed, 
dried and cauterized with the following: 

Chloride of Zinc, 1 drachm, 

Water, 1 drachm. 

Mix and apply to every part of the sore with a soft 
pine stick. After all parts of the sore have turned white 
the zinc may be washed off and the sore dressed as pre- 
viously recommended for an open sore. 



390 THE PRACTICE OF MEDICINE. 

If bubo is threatened require the patient to remain 
quiet and use the following: 

Fl. Ext. of Phytolacca Dec, \ ounce, 

Tr. of Iodine, \ ounce. 

Mix and apply over the region of the inflamed gland 
every three or four hours. If this does not control the 
inflammation, hot poultices should be used, changing them 
as they become cool, until the swelling becomes soft, 
which indicates the formation of pus. A competent sur- 
geon should now be called and the part freely incised. 
The cavity, after the incision is made, should be carefully 
cleansed with Peroxide of Hydrogen, then, washed with 
the Bichloride Solution previously recommended. Now 
dust the wound freely with Iodoform and dress with the 
Gauze. Continue to dress in this manner until the wound 
is healed. 

As soon as secondary symptoms make their appearance 
give the following: 

Bichloride of Mercury, . • 2 grains, 

Iodide of Potash, 1 ounce, 

Water, sufficient to make, 6 ounces. 

Mix and give a teaspoonful after each regular meal. 
The following is also very efficient in these cases: 

Biniodide of Mercury, 3 grains, 

Alcohol, 1 ounce. 

Mix and give ten drops in a sup of water three times 
a day after meals. 

If the patient becomes debilitated omit the alteratives 
each alternate week and give the following: 



SYPHILIS. 391 

Fl. Ext. of Nux Vomica, . . 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make,. .6 ounces. 
Mix and give a teaspoonful three times a day before 
meals. 

Ulcers appearing externally may be cieansed with 
Peroxide of Hydrogen, then, dusted with Iodoform and 
covered with Bichloride-Gauze. 

The ulcers in the mouth, throat and nose, may be 
touched with Stick-Nitrate of Silver, Tr. of Iodine, or Tr. 
of Chloride of Iron; and if considerable inflammation is 
present the throat should be steamed and then, hot poul- 
tices applied. 

The foregoing treatment is all that is required for 
constitutional syphilis in any stage, however, it might be 
added, that the patient should take a bath as hot as can 
be borne at least every third day. 

Where the beard, hair or eye-brows are lost, the follow- 
ing will be found an excellent remedy to revive the 
deadened hair-folicles : 

Fowler's Solution of Arsenic, 4 drachms, 

Tr. of Cantharides, .4 drachms, 

Glycerine, 1 ounce, 

Rose-Water, sufficient to make 8 ounces. 

Mix and rub into the scalp, face, or eye-brows, twice 
a day. 

When sleep is disturbed by pains Chloral Hydrate, 
or the Sulphate of Morphine, may be given. 



392 THE PRACTICE OF MEDICINE. 

The bowels must be kept regular. For this purpose, 
the Fl. Ext. of Cascara Sagrada may be given, when 
necessary, in from 10 to 20-drop doses, three times a day 
either increasing or diminishing the dose according to its 
effects on the bowels. 

The diet of syphilitic patients must be generous, and of 
the most nutritious character, but the use of fats must 
be prohibited. 

CHANCROID. 

SOFT CHANCRE. 

Chancroid is a local, specific, infectious disease usually 
occurring on the genital organs, as ulcers, sometimes very 
numerous and occurring from three to five days after 
exposure to its virus. 

The nature of its virus is unknown, but it is communi- 
cated by sexual intercourse and by the virus coming in 
contact with an abraded surface or mucous membrane. 

Symptoms: Unlike the hard chancre, in this, two or 
more sores frequently appear at the same time and may, 
and frequently do, appear on a person who also has a 
hard chancre. It first appears as vesicles, which, in the 
course of two or three days, are converted into pustules. 
These break and form ulcers, which have a tendency to 
coalesce, thus making one or more large sores. The pri- 
mary sore or sores, in chancroid, have a ragged mar- 
gin ; their bottoms are covered with a greyish, tenaceous 
material; and the surrounding tissues, and the base upon 
which they stand are soft, hence, the name soft chancre. 
Any portion of the patient's body may be inoculated with 



CHANCROID. 393 

the virus from one of these sores, and an ulcer, in all 
respects similar to the original, will occur at the point 
of inoculation, but this is not the case with hard chancre. 
Treatment: This is local, only, and consists of the 
same treatment that is recommended for hard chancre, 
however, the following is very efficient in these cases: 
Fl. Ext. of Echinacea Angustifolia, ... 2 ounces, 

Water, 2 ounces. 

Mix and keep the dressings of the part wet with it. 



PART VII. 

DISEASES OF THE NERVOUS SYSTEM. 

The nervous system consists of the brain, spinal cord 
and various nerves of the body. 

PHRENITIS; MENINGITIS. 

INFLAMMATION OF THE BRAIN AND ITS MEMBRANES . 

By phrenitis, or inflammation of the brain, is meant 
an inflammation of the parts contained in the cavity of 
the cranium. When the disease is confined to the mem- 
branes of the brain, it is called cerebral meningitis; and 
when it is confined to the substance of the brain, it is called 
cerebritis. The membranes and the brain substance may 
be involved at the same time ; and as it is impossible to 
decide during life which is the seat of the disease, we shall 
consider them under one head. It may occur in adults, 
as an original disease, but in children it usually occurs 
as a complication of some other disease. In some sections 
of country it is improperly called " brain-fever." 

An attack may be caused by falls, or blows on the head, 
exposure to the direct rays of the sun, intemperance, 
erysipelas of the head, prolonged mental excitement, a 
metastasis of rheumatic or gouty inflammation, cold, 
fatigue, etc., etc. 

395 



396 THE PRACTICE OF MEDICINE. 

Symptoms: The disease, although preceded by dizzi- 
ness, a sense of pain and fullness in the head, confusion 
of the mind, and disturbed sleep, is usually ushered in 
with a well-marked chill, or rigor, continuing from one, 
to five or six hours. Following this there is generally a 
very high fever, a full, rapid pulse, hot dry skin, a whitish, 
furred tongue, scanty high-colored urine, and constipated 
bowels. The head becomes hot; the face turgid; the 
eyes watery, and the pupils contracted; and there is a 
violent throbbing pain in the head. As the disease pro- 
gresses, the patient becomes more restless; the pain in the 
head increases; there is intolerance of light and sound; 
ringing in the ears; and delirium, sometimes of a violent 
form. The fever, up to the third or fourth day, is usually 
continuous, however, there is sometimes a slight remis- 
sion in the morning. 

The delirium soon becomes low and muttering; and 
the pupils, which were at first contracted are now dilated; 
the patient lies on the back; slips down towards the foot 
of the bed; picks at the bedding; and graps at imaginary 
objects. Breathing becomes stertorous; the extremities 
cold; the body covered with clammy prespiration ; and 
death shortly closes the scene. 

"It must be remembered that these symptoms vary, 
being very mild with some, and extremely violent with 
others, depending upon the degree of vital energy of the 
system, the severity of the cause, and other attending 
circumstances.' ' 



PHREXITIS ; MENINGITIS. 397 

"In children we frequently find inflammation of the 
brain making its appearance during the progress of other 
diseases. The head becomes hot, the face turgid, the 
pupils contracted, with great restlessness and constant 
movement of the head. Though not very marked on 
account of age, the child is evidently delirious, and the 
frequent movements of the head, and putting the hands 
up to it, show that it suffers pain. In other cases, the 
acute stage has passed without notice, the face is blanched 
and contracted, or white and puffy, the pulse small and 
very frequent, the extremities cool, bowels loose, the dis- 
charges being unnatural and offensive; there is continued 
movement of the head and restlessness, or a deep stupor 
or coma. Sometimes these symptoms continue three or 
four days, but at other times the disease terminates fatally 
within forty-eight hours." — Scudder. 

Treatment: Keep the head cool and the feet warm. 
The first may be accomplished by pouring cold water on 
the head, or the application to it of bags of pounded ice; 
and the latter by bathing the feet in warm water several 
times a day and afterwards applying hot rocks, bricks, 
irons, etc., to them. 

Control the fever with sedatives administered accord- 
ing to indications throughout the attack, using rather 
large doses of Gelsemium. Bromide of Potash may also 
be used in these cases. The indications for it are the 
same as those for Gelsemium. In addition to the seda- 
tives, when the fever is high and the pupils not abnor- 



398 THE PRACTICE OF MEDICINE. 

mally large 5 grains of Acetanilide may be given every 
three or four hours. 

In full-blooded patients a brisk cathartic should be 
given at the commencement of the attack; and, subse- 
quently, Salts should be used daily to keep the bowels 
open. 

Where there is scantiness of urine give the following: 

Acetate of Potash, 5 drachms, 

Water, sufficient to make, 2 ounces. 

Mix and give a teaspoonful, in a sup of water every 
three or four hours until the desired effects are obtained. 

Where the tongue is broad and pallid, the coating con- 
sisting of a dirty whitish material, give 20 grains of the 
Sulphite of Soda, in a large sup of water, every four hours 
until the color and coating of the tongue is changed. 

Where the patient is restless, unable to sleep, nervous, 
delirious or picking at the bedding, give 10 grains of the 
Hydrate of Chloral, in Mint- Water, every half-hour until 
it produces quietude, then, continue its use just often 
enough to keep the patient quiet. 

Sometimes the fever is distinctly periodic, especially 
in malarial countries. In these cases Quinine should 
be given during the remission as is recommended in remit- 
tent fever. 

If necessary to sustain the patient's strength, stimulants 
may be given; and for this purpose, the Aromatic Spirits 
of Ammonia may be given in 20 to 30-drop doses every 
one, two, or three hours as is needed. 

If the fever assumes a typhoid type, treat it as such. 



CEREBRAL HEMORRHAGE. 399 

During convalescence, every precaution must be used 
to avoid mental excitement. 

The diet should be nutritious, but easily digested, being 
careful to avoid over-taxing the stomach. 

Where the patient is greatly debilitated the following 
may be given: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis, Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces. 

Aromatic Elixir, sufficient to make,. .6 ounces. 
Mix and give a teaspoonful before each regular meal. 

CEREBRAL HEMORRHAGE. 

APOPLEXY. 

Apoplexy is the sudden rupture of an artery of the 
brain or meninges or the plugging of a cerebral vessel 
by an embolus causing pressure and more or less destruc- 
tion of brain-substance; characterized by sudden uncon- 
sciousness, irregular noisy breathing and muscular relaxa- 
tion. 

The principal cause of it is a diseased condition of 
the blood vessels of the brain. The excessive use of 
alcoholic liquors, Bright's disease of the kidneys, syphilis 
and gout are predisposing causes. One attack, on account 
of the condition of the blood vessels of the brain, predis- 
poses to another. It is rarely seen in persons under the 
age of forty. 

Symptoms: An attack may commence suddenly or be 
preceded by premonitory symptoms as headache, ringing 
in the ears; dizziness; transient deafness or blindness; a 



400 THE PRACTICE OF MEDICINE. 

sensation of numbness of the extremities; and twitchings 
of the muscles. Finally the patient falls down in a more 
or less unconscious condition; and motion and sensation 
are partly or entirely suspended. The respirations are 
shallow and noisy; during inspiration the cheek of the 
paralyzed side is drawn in and during expiration it is 
purled out; the pulse is slow and full, sometimes irregular; 
one pupil may be contracted and the other one dilated 
and they do not respond to light. The face is usually 
flushed; the carotids throbbing; and the temperature may 
be a degree or two too low, but rises within twenty-four 
hours to ioo or 101 degrees; or in very severe cases to 
107 or 108 degrees. In the latter cases death soon closes 
the scene. 

An attack may be followed by partial loss of speech, 
impairment of the mind and paralysis of various parts 
of the body. Other attacks, sooner or later, are very 
liable to follow. 

Treatment: If there are premonitory symptoms re- 
quire the patient to remain perfectly quiet; administer 
a full dose of Salts, and give 3 or 4 drops of the Fl. Ext. 
of Gelsemium every hour until relieved or until drooping 
of the eyelids or double vision is produced. 

When the attack occurs, loosen the clothing; place 
the patient in a cool quiet room, on the side with the face 
rather downwards so that the tongue and secretions will 
fall forward, instead of backwards into the pharynx. 
Apply ice or cold water to the head; place the feet in hot 
Mustard-Water, and if the pulse is full and strong give 



CEREBRAL HEMORRHAGE. 401 

one drop of the Tr. of Veratrum Viride every hour; and 
if there is throbbing pain in the head or throbbing carotids 
add 1 or 2 drops of the Fl. Ext. of Gelsemium to each 
dose of the Veratrum. When they are both used they 
may be prepared as follows: 

Tr. of Veratrum Viride, 18 drops, 

Fl. Ext. of Gelsemium, 36 drops, 

Water, 18 teaspoonfuls. 

Mix and give teaspoonful doses. 

If during the attack the face is pallid and the pulse 
weak or irregular, 20 to 30 drops of the Aromatic Spirits 
of Ammonia should be given every hour, or oftener if 
necessary; and in addition to this the following should 
be given: 

Fl. Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grand., 24 drops, 

Water, 12 teaspoonfuls. 

Mix and give a teaspoonful every two hours. 
Where any part of the body becomes swollen or 
cedematous give 3 or 4 drops of the Fl. Ext. of Apocynum 
Cannabinum four times a day. 

For the purpose of promoting the absorption of the 
clot the following should be given: 

Iodide of Potash, 1 ounce, 

Water, sufficient to make, 6 ounces. 

Mix and give a teaspoonful after each regular meal. 
The patient must avoid intemperance of every kind and 
also mental or physical excitement and worry. The bowels 
and kidneys should be kept in a normal condition. 



402 THE PRACTICE OF MEDICINE. 

SPINAL MENINGITIS. 

This is an inflammation of the membranes covering 
the spinal cord; characterized by fever, pain in the back; 
and, when the cord itself is involved, paralysis. When 
the substance of the cord is inflamed, it is called myelitis. 

The disease is due to infection from the tubercle bacil- 
lus, syphilis, typhoid fever, septicaemia, the influenza 
bacillus, etc., or the result of a wound of the spine. 

Symptoms: An attack is usually ushered in with a 
well-marked chill, followed by fever with a hot, dry skin, 
white coated tongue, scanty, high-colored urine and con- 
stipated bowels. Severe pain in the spine, aggravated 
by the slightest movement is a constant symptom. There 
are spasmodic contractions and rigidity of the muscles 
supplied by the nerves originating at the seat of the 
inflammation. When the upper part of the spine is 
involved, the patient's head is drawn backward; the 
pulse is weak, and there is difficulty in breathing and 
swallowing; or if the lower part is involved there may 
be an inability to discharge the urine and faeces, or the 
evacuations occur without the patient's knowledge. This 
is especially true when the cord itself is involved. 

About the third or fourth day the fever reaches its 
height, and soon assumes a typhoid or continued type; 
the patient becomes stupid, or there is low muttering 
delirium, and finally, when the attack is severe, or the 
result of a wound of the spine, there is paralysis, which is 
usually permanent, of the parts below the seat of the inflam- 
mation. An attack usuallv lasts from two to ten weeks. 



SPINAL MENINGITIS. 403 

Treatment: Control the fever in this as in any other 
disease, with sedatives administered according to indications. 

Require the patient to lie upon the side or face. Ap- 
ply dry cups, or a cloth, wet with the White Liniment, 
along the spine. In very severe cases, a plaster of the 
Cerate of Cantharides may be applied to the spine how- 
ever, this is rather heroic for this enlightened age. 

At the beginning of the attack the following may be 
given : 

Calomel, 1 grain, 

Powd. Ipecac, 1 grain, 

Bicarbonate of Soda, 10 grains. 

Mix, divide into five powders and give one every 
hour. If they fail to act on the bowels, Oil, Salts or a 
Seidlitz Powder should be given. Afterwards through- 
out the attack keep the bowels slightly open with the Fl. 
Ext. of Cascara Sagrada. 

For the purpose of controlling the muscular contrac- 
tions from 5 to 10 drops of the Fl. Ext. of Gelsemium 
may be given, preferably hypodermically, every half- 
hour as is required, watching its effects and discon- 
tinuing its use, temporarily, when double vision, droop- 
ing of the eyelids or under jaw is produced. 

If the tongue is broad and pallid, the coating consist- 
ing of a dirty, whitish material, give 20 grains of the 
Sulphite of Soda every three or four hours until the color 
of the tongue is changed. 

If there is scantiness of urine, give 20 grains of the 
Acetate of Potash every three or four hours until the 



404 THE PRACTICE OF MEDICINE. 

desired effects are obtained; when, it should only be 
administered occasionally, as is needed to continue its 
effects : 

If there is retention of urine, the bladder must be 
emptied, as often as is necessary, by means of a soft, 
rubber-catheter. 

If the disease is a result of syphilis, the following should 
be given: 

Bichloride of Mercury, .2 grains, 

Iodide of Potash, 1 ounce, 

Water, sufficient to make, 6 ounces. 

Mix and give a teaspoonful three times a day after 
meals. 

When the disease arises from an injury that causes 
compression of the spinal cord, no time should be lost 
in procuring the services of a competent surgeon, who 
will remove that portion of the bones of the spinal column 
causing the compression. 

When the inflammation arises as a complication of 
some other disease, an appropriate treatment for the dis- 
ease causing it should be adopted. 

If the fever assumes a typhoid type treat it as such. 

When there is paralysis the treatment recommended 
for that condition should be adopted at once. 

The system should be supported with nutritious food, 
and stimulants, when necessary. 

SPINAL IRRITATION. 

This is a condition frequently met with, especially 
in women between the ages of fifteen and twenty-five. 



SPINAL IRRITATION. 405 

It may be caused by spinal shock, or concussion 
from any cause, and all those practices and habits, which 
cause nervous strain and result in nervous exhaustion. 
It may also be induced by the excessive use of opium or 
alcoholic liquors. Hysteria often causes or accompanies 
it. 

Symptoms: Tenderness, excited either by pressure 
or motion, is a constant symptom. It may extend along 
the entire length of the spine, or be confined to a very 
small portion of it. When the affection is confined to 
the upper part of the spine, some of the following symp- 
toms are usually present: headache, dizziness, sleepless- 
ness, more or less mental disturbance, shortness of breath, 
palpitation of the heart, pain in the stomach, nausea and 
vomiting, and sometimes dyspepsia. When the irrita- 
tion is confined to the lower part of the spine, there are 
neuralgic pains and weakness in the lower limbs, pain 
in the abdominal and lumbar regions; and, in females, 
ovarian pains and disorders of menstruation. 

The symptoms are always variable and inconsistent, 
and the pains frequently shift from one part to an- 
other. 

Treatment: If possible remove the cause. Admin- 
ister 3 or 4 drops of the Fl. Ext. of Nux Vomica before 
each regular meal, and apply a Compound Tar Plaster 
to the spine, over the tender region. Require the patient 
to wear it as long as it can be borne, when it should be 
removed for a few days and then applied as before and 
thus continued until a cure is effected. 



406 THE PRACTICE OF MEDICINE. 

The bowels must be well regulated; the diet nutri- 
tious but easily digested; and the patient should take 
moderate exercise, daily, in the open air. 

LOCOMOTOR ATAXIA. 

Locomotor ataxia is a hardening (sclerosis) , of the 
posterior columns of the spinal cord; characterized by 
loss of co-ordination; neuralgic pains in the limbs; absence 
of knee-jerk; loss of sensation, and failure of the pupils 
to respond to light. 

The causes of the disease are very obscure, but it is 
believed that exposure to cold and dampness, excessive 
sexual indulgence, drunkenness, syphilis, and mental 
overwork, are largely instrumental in its production. It 
is thought, in some cases, to be hereditary. It is more 
frequently met with in men than in women; and it usually 
occurs between the ages of twenty-five and fifty. 

Symptoms: The disease usually commences with 
sharp, darting, electric-like pains in the legs, associated 
with a loss of sensation in the feet, the patient being 
unable to distinguish between hard or soft substances 
in walking; and if the upper part of the cord is involved, 
the patient is unable to button his clothing. There is a 
sensation as if ants were crawling over the surface, espe- 
cially in the legs and about the waist; and there is an 
impairment of vision and a failure of the pupils to respond 
to light; absence of knee-jerk; nocturnal emissions of 
semen, and finally impotency. 

As the disease progresses, sensation is blunted; in 
some cases, several minutes elapse, before pain is felt, 



LOCOMOTOR ATAXIA. 407 

after sticking the patient with a needle. After a time, 
all control over the motion of the legs is lost; walking 
is greatly interfered with or is impossible; and when the 
eyes are closed, it is almost impossible for the patient 
to maintain the erect position. 

Treatment: The disease is incurable, but the life 
of the sufferer can be prolonged and his discomfort lessened. 
Rest in bed, even for months, must be enjoined. The 
use of the following is said to retard its progress: 

Bichloride of Mercury, 2 grains, 

Iodide of Potash, 1 ounce, 

Water, sufficient to make, 6 ounces. 

Mix and give a teaspoonful three times a day after 
meals. The Chloride of Gold and Soda in doses of 1-20 
of a grain three times a day often remarkably retards the 
progress of the disease. The best results are said to fol- 
low the use of silver. The Nitrate of Silver may be given 
in from 1-4 to 1-2 grain, or the Oxide of Silver in 1-2- 
grain doses three times a day. When the silver is used 
its administration should be suspended at intervals of 
a few weeks to prevent discoloration of the skin. 

Electricity is recommended by some authorities and 
condemned by others. 

The pains must be controlled with Chloral Hydrate, 
Codeine or Morphine. The use of the latter should not 
be commenced as long as it can be avoided. 

The diet must be highly nutritious and of an easily 
assimilated character. 



4 o8 THE PRACTICE OF MEDICINE. 

VERTIGO. 

DIZZINESS. 

This is a condition in which the individual affected 
or the objects about him, seem to be in rapid motion, 
either of a rotary, circular, or a to-and-fro kind. It is 
not really a disease, but a symptom, and may occur as a 
result of various disorders, the most common of which 
are indigestion, nervous exhaustion, and diseases of the 
ears. When it appears in an aggravated form, it indi- 
cates disease of the brain, kidneys, liver, or heart. The 
condition is also occasionally met with in women at the 
u change of life," and as a result of suppressed menstrua- 
tion. 

Treatment: When possible, remove or relieve the 
condition causing it. If it is a result of indigestion, reg- 
ulate the diet, and adopt the treatment recommended for 
dyspepsia. 

If it is a result of nervous exhaustion, remove the cause 
and give 4 drops of the Fl. Ext. of Nux Vomica before 
each regular meal; and if the bowels are constipated, 
regulate them with the Fl. Ext. of Cascara Sagrada. 

When it arises from other causes a competent physician 
should be consulted. 

COUP-DE-SOLIEL. 

SUN-STROKE. 

"By sun-stroke is meant a sudden prostration of the 
nervous system, as a result of extreme heat." 

Symptoms: "The symptoms that indicate an approach- 
ing sun-stroke are a heavy feeling in the head, dizziness, 






COUP-DE-SOLIEL. 409 

derangement of vision, ringing in the ears, faintness, 
and difficult breathing. Sometimes these symptoms are 
absent, and the patient falls unconscious without 
warning. 

" After the attack the pulse is frequent and irregular; 
breathing is difficult; the face is of a dusky, red color; 
the head is hot; nausea and vomiting are usually present; 
and sometimes the bowels and bladder move involun- 
tarily." 

"In severe cases these symptoms may continue to 
increase, and the disease terminates fatally in a few 
hours, while in others, they gradually subside, and the 
patient slowly regains consciousness. The sufferer is 
greatly prostrated for some time after the sun-stroke. 
Dizziness and faintness come on after the slightest mental 
effort; and a full distressed feeling in the head continues 
to affect him for months afterwards." — Gunn. 

Treatment: The patient should be immediately re- 
moved to the shade and placed in a recumbent position, 
being careful to allow a free circulation of air. Apply 
cold water, or bags of pounded ice to the head; and stim- 
ulants to the extremities. Give stimulants, such as 20 to 
30 drops of the Aromatic Spirits of Ammonia, repeated 
every half-hour or so, or Brandy or Whiskey freely. The 
latter may be used hypodermically if the patient can not 
swallow. If these are not at hand, from 1-40 to 1-30 
of a grain of the Sulphate of Strychnine may be given 
every three or four hours, preferably hypodermically. 
If the pulse is weak the following should also be used: 



410 THE PRACTICE OF MEDICINE. . 

Fl. Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grand., 24 drops, 

Water, .12 teaspoonfuls. 

Mix and give a teaspoonful every two hours until the 
pulse becomes normal. 

When improvement begins, keep the patient quiet; 
continue the stimulants in small quantities; withhold all 
indigestible articles of food; and keep the bowels well 
regulated with the Fl. Ext. of Cascara Sagrada. 

The nervous system may be greatly strengthened by 
the use of 4 drops of the Fl. Ext. of Nux Vomica before 
each regular meal. 

CHOREA. 

. ST. VITUS' DANCE. 

Chorea, or St. Vitus' dance, is a disease of the nervous 
system, usually occurring between the ages of six and 
sixteen; characterized by constant twitchings and irregu- 
lar movements of the voluntary muscles, especially of 
the face and limbs. Girls are more subject to it than boys. 

The most common causes of it are thought to be mental 
emotions, fright, falls, injuries, worms, masturbation, and 
debility from previous disease. In some cases, it is thought 
to be hereditary. Some authorities believe that it is 
infectious, but there seems to be no evidence whatever 
to support such a belief. 

Symptoms : The disease commences with convulsive 
movements, or rather twitchings, of the fingers, muscles 
of the face, or other parts of the body. These, at first, 
are slight, but as the disease advances, they gradually 



CHOREA. 411' 

increase, until, in severe cases, the hands can not be con- 
trolled sufficiently to write or work. Walking is difficult; 
speech is affected ; and the patient makes wry faces, seem- 
ingly on purpose. During sleep these irregular move- 
ments abate, or cease. Should the disease continue any 
considerable length of time, the mind becomes somewhat 
blunted, and the memory impaired. 

Treatment: Confine the patient to bed in a dark- 
ened room, and if the cause of the disease can be 
determined, remove it. 

If the bowels are constipated regulate them with Fl. 
Ext. of Cascara Sagrada. It may be given in from 5 
to 20-drop doses before each regular meal, either increas- 
ing or diminishing the dose according to its effects. 

Where there is scantiness of urine, give from 15 to 
20 grains of the Acetate of Potash, largely diluted with 
water, four or five times a day. 

If the muscular movements interfere with sleep, the 
Hydrate of Chloral should be given. 

Our principal remedy in the treatment of chorea is 
Fowler's Solution of Arsenic. The dose, at first, should 
not exceed one or two drops three times a day, after meals, 
but the dose may be gradually increased to 10 drops three 
times a day and continued until it produces oedema, or 
swelling of the tissues around the eyes, or slight disturb- 
ance of the stomach or bowels, when, the dose should 
be gradually decreased until the symptoms produced 
by the remedy disappear. 



412 THE PRACTICE OF MEDICINE. 

The Fl. Ext. of Black Cohosh is also an efficient 
remedy in these cases, especially where the disease follows 
an attack of rheumatism. It may be given in the form of 
the Fl. Ext. in from 10 to 30-drop doses three times a day. 

The diet should be nutritious but easily digested. 

EPILEPSY. 

Epilepsy is a chronic disease of the nervous system, 
usually beginning in early life; characterized by parox- 
ysms of sudden loss of consciousness, and convulsions. 
These paroxysms occur at irregular intervals, the periods 
between them, in some cases, being only a few minutes, 
or hours, while in others several days, or even months, 
may elapse. 

The disease in many cases, is the result of an inherited 
tendency; while in others, it is the result of intemper- 
ance; excessive sexual indulgence; self- abuse, fright, 
mental worry, blows on the head, syphilis, diseases of 
the womb, thickening of the membranes of the brain; 
and tumors of the brain. 

Treatment: All that can be done during the parox- 
ysms is to loosen the clothing around the neck and waist; 
place a cork or a soft piece of wood between the teeth, 
to prevent the patient's biting the tongue; and if the face 
is turgid, pour cold water on the head. As soon as the 
convulsion passes off, from 5 to 10 drops of the Fl. Ext. 
of Gelsemium should be given, preferably hypodermically. 
Should this fail to afford relief the dose may be repeated 
every thirty minutes until the desired effects are obtained, 
or until three doses have been given. 



EPILEPSY. 413 

If the paroxysms are preceded by premonitory symp- 
.toms, the patient should carry a vial of the Nitrite of 
Amyl in the pocket, and when these are felt from 3 to 5 
drops of it should be dropped on a handkerchief and 
inhaled. A few whiffs of Chloroform answers the same 
purpose. 

With a view of making a permanent cure determine 
the cause, if possible, and remove it; keep the bowels 
and kidneys in a normal condition and administer 20 
grains of the Bromide of Potash, or the same amount 
of the Bromide of Ammonium, three times a day; or 
if the patient is syphilitic the following will answer a 
better purpose: 

Bromide of Potash, 2 ounces, 

Iodide of Potash, 1 ounce, 

Water, sufficient to make, 6 ounces. 

Mix and give a teaspoonful three times a day after 
meals. 

Where the patient is weak and anaemic, the following 
should be given instead of the foregoing: 

Sulphate of Strychnine, 1 grain, 

Hydrochloric Acid, 4 drops, 

Water, 4 ounces. 

Mix and give a teaspoonful before each regular meal. 
Whichever of the foregoing remedies are beneficial 
in any particular case, the permanency of the relief can 
only be maintained by the continuation of the drug for 
at least two years after the last attack. The disease, 
in the great majority of cases, is incurable, therefore the 



414 THE PRACTICE OF MEDICINE. 

"never-failing" remedy advertised by dishonest quacks 
should be avoided. 

HYSTERIA. 

Hysteria, or hysterics, is a functional disorder of the 
nervous system, of the nature of which it is impossible 
to speak definitely; characterized by disturbance of the 
will, reason, imagination and the emotions, as well as 
motor and sensory disturbance. 

The predisposing cause of hysteria is a peculiar con- 
dition of the nervous system, either inherited or acquired, 
the peculiar manifestations being excited by disturbance 
of either the sexual organs, the digestive, circulatory, or 
nervous system. The disease is confined almost exclu- 
sively to women. 

Symptoms: "The subject of hysteria usually com- 
plains of a feeling of oppression, anxiety and uneasiness. 
At one time she seems exceedingly joyous and laughs 
inordinately; and at another, she will cry without the 
slightest occasion, and will seem weighed down with sad- 
ness. A feeling as if a ball or lump, in the throat, is 
frequently present, which the patient says she can neither 
get up nor .down; the limbs are stiff and painful; there 
are noises in the ears; confusion of the mind and dizzi- 
ness come on; and finally a temporary loss of conscious- 
ness takes place, during which short intervals of quiet 
are followed by violent muscular contractions, throwing 
around of the arms and legs, pulling the hair, and grind- 
ing the teeth. 



HYSTERIA. 415 

" During these attacks the patient will struggle with 
her friends or attendants, will use abusive language, and 
will scream, laugh, and cry in rapid succession. During 
such an attack the heart palpitates violently, the face 
becomes flushed and swollen, and the breathing is diffi- 
cult." 

"These attacks may pass off in a few minutes, or may 
continue for several hours or even days. The excitement 
passes over, and the patient falls asleep, and when she 
awakens consciousness is restored." 

"In some cases she gradually comes to herself with- 
out sleep. After a severe attack she feels weak and sore 
for several days." 

"In mild cases, periods of excitement, followed sud- 
denly by mental depression, may occur without the 
convulsions. The lump is felt in the throat, and the 
patient imagines she is suffering from a great variety of 
diseases. She can not sew, write, read or walk, with- 
out great fatigue, and she soon loses her appetite and 
becomes pale and thin." — Gunn. 

Treatment: Little, as a rule, need be done to check 
the convulsions unless they are violent or prolonged, in 
such cases, administer from 5 to 10-drop doses of the 
Fl. Ext. of Gelsemium, preferably hypodermically, every 
half -hour until relief is obtained, or double vision or 
drooping of the eyelids is produced. One dose is usually 
all that is required. 

Hysterical patients frequently complain of a smother- 
ing sensation. In these cases, 20 to 30 drops of the Aro- 



416 THE PRACTICE OF MEDICINE. 

matic Spirits of Ammonia, given in a sup of water, every 
thirty minutes, usually affords prompt relief. 

If the bowels are constipated regulate them with the 

Fl. Ext. of Cascara Sagrada; if the patient is afflicted with 

any " female trouble," it should receive proper treatment. 

When the patient is debilitated the following should 

be given: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Fowler's Solution of Arsenic,. . .ij drachms, 
Aromatic Elixir, sufficient to make,. 6 ounces. 
Mix and give a teaspoonful before each regular meal. 
Pulsatilla is a valuable remedy in these cases, espe- 
cially where there is nervousness with depression of 
spirits. The Fl. Ext. of it may be given in from 3 to 5- 
drop doses three times a day. 

Regular habits and the avoidance of all excitement 
must be enjoined. 

TETANUS. 

LOCK-JAW. 

Tetanus is an acute infectious disease; characterized 
by persisting rigidity of the muscles of the jaws and neck, 
and frequently of the greater part of the voluntary muscles 
of the body, with paroxysms of tonic spasms, the intellect 
remaining unimpaired. 

It is said to be idiopathic when no open wound is dis- 
coverable; traumatic, when following a wound; and 
tetanus neonatorum when occurring in the new-born. 



TETANUS. 417 

It is caused by the tetanus bacillus, which gains access 
to the system through some wound, usually a punctured 
wound of the extremities. Many recent writers claim 
that the disease is never idiopathic, however, they admit 
that the wound may be so trivial as to entirely escape 
notice. The bacilli are found everywhere, but most 
numerous in barn-yards, gardens, rubbish and putrefying 
liquids. 

Symptoms: " Sometimes tetanus comes on suddenly 
and with great violence; but more generally it occurs 
gradually, differing greatly in various cases, both in 
severity of its symptoms, and in the manner of the attack. 
Usually, the first symptom is a slight sensation of stiff- 
ness in the back part of the neck, which increases, render- 
ing any motion of the head both difficult and painful, 
with an uneasy sensation at the root of the tongue, and 
difficulty in swallowing. A great tightness about the 
chest, and a severe pain at the lower part of the breast- 
bone, shooting into the back, are also present. The spasms 
of the neck become more violent, the jaws gradually 
become stiff with the teeth closely set together; spasms 
at the pit of the stomach and of the muscles of the 
abdomen take place, the abdomen feels very hard, the 
body is curved in some direction, or remains rigidly erect, 
with obstinate constipation and excruciating pain, and 
finally convulsions and death. Generally, in this dis- 
ease, the eyes are rigid and immovable in their sockets, 
the countenance is hideously distorted and manifests 
great distress; the pulse becomes irregular; the strength 



4 i8 THE PRACTICE OF MEDICINE. 

exhausted; and there is frequently a cold, clammy 
perspiration. Death may be produced by suffocation, or 
exhaustion. When it proves fatal it is generally from the 
fifth to the tenth day, and the younger the patient, the 
more rapidly fatal it is; sometimes one universal 
spasm terminates life." — King. 

Treatment: This in the hands of the unprofessional 
is unsafe, therefore, the treatment is not given in this 
work. 

PARALYSIS. 

"Paralysis is a term applied to a condition in which 
there is a partial or complete loss of motion or sensation, 
or both, in some part of the body. It is not a disease, 
but a symptom of several diseases that affect the brain 
and spinal cord." 

" Paralysis may follow apoplexy, inflammation of the 
brain, softening of the brain-substance, the formation of 
tumors inside of the skull, and injuries of the head, that 
cause bleeding within the skull; or injuries of the spinal 
cord. When the paralysis is caused by any of these con- 
ditions of the brain, it usually affects one entire side of 
the body, and is then called hemiplegia." 

"When the spine is involved, all that part of the body 
below the seat of the disease or injury is paralyzed, and 
the condition is called paraplegia." 

"If there is any injury of, or pressure on, a large nerve 
supplying a limb or a single muscle, the part so supplied 
will be paralyzed." 



PARALYSIS. 419 

"In some cases the paralysis comes on suddenly, 
while in others its development is gradual. Sometimes 
motion is lost while sensation remains normal, again 
motion may be present while there is no feeling in the 
part; but usually both motion and sensation are destroyed." 

"In some cases the skin of the back and affected side 
is over sensitive, to such a degree that the slightest touch 
will occasion great suffering." 

Symptoms: "Inability to speak, and loss of motion 
or sensation, or both, on one side, with the face drawn 
to the opposite side, indicate paralysis from causes orig- 
inating in the brain. Loss of motion and sensation below 
a fixed point in the back, and entire freedom from head- 
symptoms indicate that the seat of the trouble is located 
in the spine. When only one limb or one muscle or set 
of muscles, is paralyzed, it indicates that a large nerve is 
involved." 

"Whatever the cause of paralysis, when it once occurs 
a long time is necessary to restore the normal functions 
of the affected parts, and in many cases, a recovery from 
one attack is no protection against another." — Gunn. 

Treatment: The physician should determine the 
nature of the exciting cause of paralysis, and do what he 
can to relieve that. The most successful treatment con- 
sists in the proper use of electricity. The alternate use 
of the faradic and galvanic currents will usually prove 
the most serviceable. The following may also be used: 

Sulphate of Strychnine, 1 \ grains, 

Hydrochloric Acid, 4 drops, 



420 THE PRACTICE OF MEDICINE. 

Dilute Phosphoric Acid, i ounce, 

Glycerine, i ounce, 

Water, sufficient to make, 6 ounces. 

Mix and give a teaspoonful before each regular meal. 

Due attention must be given to the diet, which should 
be of the most nutritious character. If the bowels are 
constipated the Fl. Ext. of Cascara Sagrada should be 
given three times a day until they are well regulated; 
and whenever the urine is scanty 20 grains of the Ace- 
tate of Potash should be given every four hours. 

Attention must also be given to the skin. A tepid 
sponge-bath should be given every morning, and the 
entire body rubbed thoroughly with a coarse towel. 
This treatment, however, should be followed out under 
a physician's direction, as it may be found necessary 
to vary it from time to time 

INFANTILE CONVULSIONS. 

SPASMS. 

These are violent, spasmodic, involuntary, alternate, 
muscular contractions and relaxations usually accom- 
panied by loss of consciousness and followed by stupor. 
There are two forms of them; Clonic and Tonic. In the 
first, the spasmodic movements are of short duration and 
alternate with periods of relaxation; in the latter, there is 
unintermitting muscular rigidity. The first named is the 
form usually seen. 

They may occur from a variety of causes, as organic 
brain diseases; a neuropathic tendency; fright, rickets, 



INFANTILE CONVULSIONS. 421 

meningitis, uraemia, dentition and worms, but the most 
common cause is congestion of the brain. 

Symptoms : These are so well known that a descrip- 
tion is thought to be superfluous. 

Treatment: When the head is kept cool and the 
feet warm during fever and the sedatives used according 
to indications, convulsions in children will rarely be seen 
except as a result of meningitis or some organic brain 
lesion, however, some diseases are ushered in with con- 
vulsions. When convulsions do occur, if possible, ascertain 
the cause and remove it. 

Undoubtedly our most efficient antispasmodic is Chloro- 
form. A few drops of it may be put on a napkin or hand- 
kerchief and held over the nose and mouth of the little 
sufferer. A very small amount is usually sufficient. 
Chloral Hydrate is also efficient in these cases. It . may 
be given in doses of 1 grain for each year of age up to 
twenty, repeating the dose every thirty minutes until the 
convulsions are checked. The Sulphate of Morphine, 
given hypodermically, will control them where all other 
remedies fail, but the greatest of care must be exercised 
in its use with young children. 

Where there is flushed face, bright eyes and contracted 
pupils large doses of the Fl. Ext. of Gelsemium should be 
given. The Bromides may also be used in these cases, 
especially the Bromide of Ammonium. It may be given 
in doses of 1 grain for each year of age up to twenty. 

Where convulsions are a result of organic brain disease 
very little, towards effecting a cure, can be accomplished. 



422 THE PRACTICE OF MEDICINE. 

NEURALGIA. 

Neuralgia is a disease of the nervous system; charac- 
terized by sharp, darting pains, without inflammation or 
other disorder, except that of a nerve or nerve-center 
involved. It may affect any of the sensitive nerves, but 
is usually confined to one side of the body. When it is 
confined to the face it is called tic douloureux; when to 
the sciatic nerve, sciatica; when to the side, pleurodynia; 
when to the stomach gastrodynia; and when to the heart, 
angina pectoris. We have already noticed some of these 
and will group the remainder of them together in this 
article. 

Any thing that enfeebles the body may be the predis- 
posing cause of an attack. The most common exciting 
causes are malaria, exposure to cold or damp, mental 
excitement or worry and decayed teeth. 

Symptoms: In some cases an attack commences with 
a slight sense of heat, or a sense of itching or numbness, 
which increases more or less rapidly. In others it com- 
mences suddenly, with a sharp, darting pain, which occurs 
from time to time at longer or shorter intervals. The pain 
is sometimes periodic, that is, it occurs at a certain time 
each day. When it commences of a morning and 
subsides of an evening it is sometimes called a ''sun- 
pain." This form is particularly frequent in malarial 
districts. 

If not relieved by treatment the disease continues; 
the system suffers, and the patient may finally die, worn 
out from the repeated shocks and nervous irritation. 



CEPHALALGIA. 423 

Treatment: Require the patient to assume the 
recumbent position and administer from 5 to 10 drops 
of the Fl. Ext. of Gelsemium every hour until the pain 
is relieved, or until double vision, drooping of the eyelids 
or falling of the under jaw is produced. Bathe the affected 
parts freely with equal parts of Chloroform and the Fl. 
Ext. of Aconite or instead of this apply a cloth saturated 
with the White Liniment. Regulate the bowels with the 
Fl. Ext. of Cascara Sagrada, administered before each 
regular meal; and if there is scantiness of urine give 20 
grains of the Acetate of Potash every four hours. 

If the pain is periodic give Quinine as is recommended 
in intermittent fever. 

With a view of making a permanent cure administer 
the following: 

Quinidine, 3 drachms, 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fowler's Solution of Arsenic, 2 drachms, 

Simple Syrup, sufficient to make,.. 6 ounces. 
Mix and give a teaspoonful before each regular meal. 
Where there is no malarial complication, the Quinidine 
may be omitted from the prescription. 

CEPHALALGIA. 

HEADACHE. 

Cephalalgia, literally, means pain in the head. It is 
one of the most common affections to which human flesh 
is heir. Several forms of it are recognized, as bilious, 
nervous, rheumatic, etc. 



424 THE PRACTICE OF MEDICINE. 

The usual causes of it are over-exertion, especially 
during warm weather; remaining in a crowded or over- 
heated room; fermentation of the food in the stomach; 
constipation of the bowels; excitement; the excessive use 
of stimulants; missing an accustomed meal; loss of sleep; 
cold; biliousness, etc. 

Treatment: Where the skin and whites of the eyes 
are yellow give 30 drops of the Fl. Ext. of Chionanthus 
Virginica before each regular meal. 

If it results from an overloaded stomach or a fermen- 
tation of the food in this organ give 20 grains of Powd. 
Ipecac, in a half cup of warm water. 

If there is chronic indigestion adopt the treatment 
that is recommended for this disease. 

If the bowels are constipated, treatment for their relief 
must be given. 

To relieve a paroxysm the following is specific. 

Fl. Ext. of Gelsemium, 5 drops, 

Acetanilide, 5 grains. 

Mix and give at one dose and if not easy in an hour 
the second dose may be given. 

ODONTALGIA. 

TOOTHACHE. 

By odontalgia or toothache is meant a painful con- 
dition of the nerve in a tooth. It usually results from 
caries, by which the nerve in the tooth is exposed to air, 
etc., however, a very severe form of it is sometimes caused 
by an abscess (apical) at the root of the tooth. 



ODONTALGIA. 425 

Treatment : The following will usually afford marked 
relief : 

Creosote, 1 drachm, 

Oil of Cloves, 1 drachm, 

Fl. Ext. of Aconite, 1 drachm, 

Chloroform, 1 drachm. 

Mix and apply to the cavity of the tooth on lint. 

The pain will certainly recur, sooner or later, and may 

lead to severe facial neuralgia, unless the tooth is treated 

and filled, or extracted. Persons, who have decayed 

teeth should lose no time in consulting a competent dentist. 



PART VIII. 

MISCELLANEOUS DISEASES. 
POISONOUS BITES AND STINGS. 

Persons are occasionally bitten by poisonous serpents 
or tarantulas, especially in newly settled communities, 
but more commonly they are stung by the bee, wasp and 
hornet or others of like species. 

The history of such cases is usually very plain, there- 
fore, a mistake is rarely made. 

The effects of the bite of a poisonous serpent appear 
within a few minutes after the patient receives the virus. 
There is more or less swelling of the part, sometimes of 
the entire limb, which may become mottled from an extra- 
vasation of blood; the pulse becomes weak and the patient 
extremely prostrated; the countenance pale; the extremities 
cold; the skin covered with a cold perspiration; the patient 
drowsy; and there may appear later, if the patient survive, 
an open sore or ulcer at the point where the virus entered. 

The sting of the lizard, bee, wasp, hornet or others of 
like species is similar in kind but different in degree. 
Where there have been but one or two stings received 
only local symptoms usually result, consisting of consider- 
able swelling at the point, which is pale with a red areola. 

427 



428 THE PRACTICE OF MEDICINE. 

In extremely susceptible persons, a single sting may 
produce great prostration, but more commonly this is 
not seen unless the person has been stung in many places, 
when the depression is similar to that produced by the 
bite of the poisonous serpent. 

When a person is bitten by an animal suffering with 
hydrophobia, usually the dog, fox, wolf, cat or skunk, no 
symptoms other than those that would be produced by a 
simple wound of the same extent appear until six weeks to 
three or four months afterwards, however, in young 
persons, or where the infection is great, hydrophobia may 
develop earlier. 

Probably not half the persons bitten by rabid animals 
develop hydrophobia. This may be on account of the 
animal's teeth usually passing through clothing before 
entering the person's flesh and the practice of cauterizing 
all such wounds. 

Treatment: Where a person is bitten by a poisonous 
serpent, the wound, where there are no hollow teeth or 
sores on the lips or in the mouth, should be thoroughly 
sucked at once, and a bandage applied to the limb, 
between the wound and the heart, in order - to prevent, 
as much as possible, the circulation of blood in the part, 
thereby preventing the poison's gaining entrance to the 
general circulation. Where the wound is on a part that 
can not be applied to the mouth take a sharp knife and 
incise the part where the fang entered and then apply 
cups to the part. This is accomplished by putting a small 
piece of burning paper in a glass or a quinine bottle, which 



POISONOUS BITES AND STINGS. 429 

has previously been moistened with water, and quickly 
applying the mouth, while the paper is burning, to the 
part in such a manner that air can not enter the vessel 
and the job is accomplished. 

Administer 30 drops of the Fl. Ext. of Echinacea 
Angustifolia every two hours and keep clothes wet with 
the same applied to the place where the serpent's fang 
entered. 

Where the pulse is weak give the following: 

Fl. Ext. of Digitalis, 12 drops, 

Fl. Ext. of Cactus Grand., 24 drops, 

Water, 12 teaspoonfuls. 

Mix and give a teaspoonful every two hours. When 
the pulse is extremely weak 1-40 to 1-30 of a grain of the 
Sulphate of Strychnine should be given every three or 
four hours. The Aromatic Spirits of Ammonia should 
also be given, at the same time, in from 20 to 30 drop 
doses every one, two, or three hours. Whiskey is also 
beneficial in these cases but it should not be given in 
sufficient amounts to produce drunkenness, however, 
owing to the depressing effect of the virus, considerably 
more of it may be borne than under ordinary circum- 
stances. 

Where a person has been bitten by a rabid animal 
the wound should be cleansed of the virus as in snake-bite 
and then thoroughly cauterized with Carbolic Acid. If 
this treatment is used at once very few cases of hydro- 
phobia would occur in persons who had been bitten by 
rabid animals. 



430 THE PRACTICE OF MEDICINE. 

After the wound is cauterized the 'Echinacea should 
be used as in snake-bite. 

SCROFULA. 

Scrofula is a chronic infectious disease of the lym- 
phatic glands; characterized usually by an enlargement 
and hardness of the glands of the neck. 

It is caused by the tuberculosis bacillus and is most 
commonly seen in children. 

Symptoms: "The first, most common, and distinctive 
symptom of Scrofula, is enlargement of the lymphatic 
glands, especially those about the neck. These enlarge- 
ments or tumors may remain in an indolent condition 
for a long time, neither increasing nor diminishing in 
size, and causing no pain nor other disagreeable symp- 
tom. Occasionally they may disappear, being removed 
by the powers of the system, but more generally, they 
gradually advance, become inflamed and painful, soften, 
and eventually discharge matter of a thin ichorous 
nature, mixed with curdy or cheese-like flakes. At first 
this matter is discharged from several small sinuses or 
openings; but eventually these combine, forming ulcers 
with jagged and uneven edges, which are very indolent, 
healing slowly and leaving unsightly scars when they 
do heal. They are apt to be succeeded by other tumors, 
which run a similar course, and the disease may continue 
in this manner for a number of years until it is cured, 
or the system is destroyed by it. The predisposition 
to scrofula may be transmitted from generation to gen- 
eration, not manifesting itself in one generation, while 



SCROFULA. 43t 

severely inflicting another; yet it is not invariably the 
case, that children born of scrofulous parents are affected 
with scrofulous diseases; for often but one child is affected 
while the rest of the children, to all appearance, present 
no symptoms of it whatever." — King. 

Treatment: This should be commenced by the ad- 
ministration of the following: 

Bichloride of Mercury, i J grains, 

Iodide of Potash, i ounce, 

Water, sufficient to make, 6 ounces. 

Mix and give a teaspoonful after each regular meal. 
If the patient is debilitated the following should be 
given : 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Fowler's Solution of Arsenic, i\ drachms, 

Aromatic Elixir, sufficient to make,. .6 ounces. 
Mix and give a teaspoonful before each regular meal. 
Some writers recommend Cod Liver Oil in these cases, 
but we have never seen much, if any, good follow its use. 
Where there are ulcers that have no disposition to 
heal, cleanse them thoroughly two or three times a day 
with Peroxide of Hydrogen after which wash them with 
a 1 to 1000 solution of Bichloride of Mercury, then, 
dust them well with Iodoform and cover them carefully 
with Bichloride Gauze. 

In obstinate cases, it is better to remove the glands 
before suppuration is established. 



432 THE PRACTICE OF MEDICINE. 

Let the patient have plenty of exercise in the open air 
and good nutritious food. 

Whatever line of treatment is adopted it must be 
continued, in some cases, for months, and probably years, 
in order to be successful. 

RHEUMATISM. 

Rheumatism is a disease the exact nature of which 
is unknown, though it is probably infectious. There 
are three forms of it; acute articular, chronic articular 
and muscular. 

In former times it was thought to be caused by an 
excess of lactic acid in the blood, but it is now believed 
to be due to a microorganism, probably the bacillus of 
Achalme, however the predisposing causes are heredity, 
strains, and exposure to cold and damp. Males are 
more subject to it than females. One attack predisposes 
to another. 

ACUTE ARTICULAR RHEUMATISM. 

Acute articular rheumatism is characterized by fever, 
inflammation in and around the joints, occurring in suc- 
cession and a tendency to endocarditis or pericarditis. 

Symptoms: An attack is usually ushered in with a 
chill, followed by fever, pain and stiffness of one or more 
joints, constipation of the bowels, scanty, high-colored 
acid urine and later profuse acid perspirations. 

The pain soon becomes acute, boring, tearing, or 
gnawing; the joints tender, red, and swollen; and the 
slightest movement of the affected joints increases the 
pain until it is almost unbearable. The inflammation 



ACUTE ARTICULAR RHEUMATISM. 433 

subsides in the joints affected and other joints are attacked. 
Fever with evening exacerbations and morning remissions 
continues throughout the attack. 

Uncomplicated cases usually recover in from two to 
four weeks, however, they may continue six weeks or 
longer. Relapses are frequent. 

When the attack is mild the term subacute rheuma- 
tism has been applied to it. 

An attack may be complicated with pericarditis, 
endocarditis, myocarditis, inflammation of the lining 
of the arteries of the brain, bronchitis, pneumonia, or 
pleurisy. 

Treatment: Control the fever throughout the attack 
with sedatives administered according to indications; and 
if the fever is high from 3 to 5 grains of Acetanilide 
should be given every three or four hours, however it 
should be remembered that Acetanilide should not be 
given when the pulse is weak or irregular. 

The following, in these cases, is the most efficient 
combination that we have had any experience with: 

Salicylate of Soda (from Oil of 

Wintergreen) , ' 1 ounce, 

Fl. Ext. of Cimicifuga, 6 drachms, 

Fl. Ext. of Phytolacca Dec, 1 \ drachms, 

Aromatic Elixir, sufficient to make,. .6 ounces. 

Mix and give a teaspoonful every three hours until 
the pain subsides; when, it should be given four times a 
day until the patient fully recovers. 



434 THE PRACTICE OF MEDICINE. 

Pain should be controlled throughout the attack with 
the Sulphate of Morphine in doses of \ of a grain every 
two to four hours as is absolutely required. 

If the tongue is broad and pallid, the coating con- 
sisting of a dirty, whitish material, 20 grains of the 
Sulphite of Soda may be given every four hours; or if 
the tongue is of a deep, red color, instead of the Sulphite 
of Soda 3 drops of Hydrochloric Acid, largely diluted 
with water, should be given every four hours. 

When there is scantiness of urine, the following 
should be given: 

Acetate of Potash, 5 drachms, 

Water, sufficient to make, 2 ounces. 

Mix and give a teaspoon ful every three or four hours 
until the desired effects are obtained. 

Keep the bowels open throughout the attack. For 
this purpose Oil or the Fl. Ext. of Cascara Sagrada may 
be given as is necessary. 

Where the joints affected are other than the hips or 
shoulders they should be carefully bandaged with a 
roller bandage, which should be applied wet with hot 
water. If it is the ankle or knee that is affected com- 
mence at the toes and apply the bandage evenly, using 
considerable pressure, to six or eight inches above the 
afflicted joint; and it will be found that within twelve 
or eighteen hours the swelling is reduced to such an 
extent that the bandage is loose. When the bandage 
is first applied the pain is increased but this, in the course 
of a few hours, subsides. When the affected joint is in 



CHRONIC ARTICULAR RHEUMATISM. 435 

the arm the bandage should commence at the fingers. 
If the patient is extremely debilitated after the attack 
the following should be given: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., , 1 ounce, 

Fl. Ext. of Gentian 3 ounces. 

Aromatic Elixir, sufficient to make, 6 ounces, 
Mix and give a teaspoonful before each regular meal. 
Where the joints remain sore after an attack the 
following should be given: 

Iodide of Potash, 1 ounce, 

Fl. Ext. of Phytolacca Dec, 3 drachms, 

Compound Syr. of Stillingia, to make, 6 ounces. 
Mix and give a teaspoonful after each regular meal. 
Rheumatic patients should avoid the use of alcoholic 
liquors and wear flannel next to the body the entire year. 

CHRONIC ARTICULAR RHEUMATISM. 

This is a mild but persistent inflammation of the 
ligaments, synovial membrane, cartilages and sometimes 
the capsule of the joints. It may be limited to any one of 
these structures, or it may invade them all at the same 
time. 

It may be produced by the same causes that produce 
the acute form of the disease and may follow an acute 
attack. The greatest number of these cases occur be- 
tween the ages of forty and sixty. Females are slightly 
more subject to it than males. Residing in unhygienic 
surroundings and exposure to cold and damp predispose 
to it. Its development may be favored by heredity. 



436 THE PRACTICE OF MEDICINE. 

Symptoms: Unlike the preceding form of the disease 
in this there is usually no fever, the principal symptoms 
being a deep, aching pain with only very slight, if any, 
swelling and more or less tenderness in one or more of 
the joints, usually the larger ones. Persons with rheu- 
matic joints are generally great weather prophets, often 
being able to foretell the coming of a storm, or a change 
in the weather. After rest motion gives considerable pain, 
but after exercise the joint becomes more supple and less 
painful. The pain is limited to the joints affected and 
does not change from one to another. 

The disease undergoes exacerbations and remissions 
and may continue for years without causing much de- 
formity or crippling of the joints. The muscles near 
the affected joints finally become atrophied, thus causing 
the joints to look larger than they really are. The joints 
are more or less stiffened, and when moved a creaking 
noise may usually be heard. 

Treatment: When the joints are swollen and very 
painful, the treatment recommended in the acute variety 
of the disease should be given until the pain and swelling 
subside to some extent, however, sedatives must not be 
given unless the patient has fever. 

With a view of making a permanent cure the fol- 
lowing should be given: 

Iodide of Potash, i ounce, 

Fl. Ext. of Cimicifuga, i| ounces, 

Fl. Ext. of Phytolacca Dec, 3 drachms, 



MUSCULAR RHEUMATISM. 437 

Fl. Ext. of Colchicum Seed, 2 J drachms, 

Compound Syr. of Stillingia, to make, 6 ounces. 

Mix and give a teaspoonful after each regular meal. 
If it acts too freely on the bowels decrease the amount 
of Colchicum. 

Apply the White Liniment freely to the affected 
joints, using considerable friction in applying it. Give 
the patient a general bath in water as hot as can be 
borne, in a warm room at least three times a week. If 
the bowels are constipated regulate them with the Fl. 
Ext. of Cascara Sagrada. If there is scantiness of urine 
give 20 grains of the Acetate of Potash every four hours 
as is required. 

The diet of persons afflicted with chronic rheumatism 
must be highly nutritious, but non-stimulating. They 
should wear flannel next to the skin the entire year, and 
avoid exposure to sudden changes in the atmosphere and 
cold and damp. 

MUSCULAR RHEUMATISM. 

This is a rheumatic affection of the voluntary mus- 
cles, accompanied by pain, tenderness, and stiffness of 
the affected muscles, but by no other evidences of inflam- 
mation. It may affect any or all of the voluntary 
muscles, but the ones most commonly affected are those 
of the back and neck. 

It is a disease of adult life, however, it is occasionally 
seen in children of the gouty or rheumatic. It is often 
intimately associated with articular rheumatism, which 
sometimes precedes or follows it. The same cause that 



438 THE PRACTICE OF MEDICINE. 

produces acute articular rheumatism probably produces 
this form of the disease. The sudden straining of a 
muscle predisposes to an attack. 

Symptoms: "An attack usually comes on suddenly 
with severe, deep-seated pain in the group of muscles 
affected. The pain is of a stretching or tearing character, 
increased by movements or pressure. It is always more 
severe at night, and remits, or disappears during the 
day. It may be migrating, or remain fixed in certain 
muscles. It is usually acute when the muscle is in action, 
and dull when the parts are at rest. Certain positions 
mitigate the pain. In many instances it will wholly 
disappear in a few minutes, and the sufferer, who, per- 
haps, has been for hours enduring excruciating, cramp- 
like pain, feels a sudden sense of relief. In some cases 
there is fever. Such attacks are followed by lassi- 
tude." — Loomis. 

When the muscles of the back are affected, it is called 
lumbago. In this the patient is unable to bend back- 
wards or forwards, and if the pain comes on while he is 
in a sitting posture, he is compelled to walk with the body 
bent at the hips. 

When the muscles of the neck are affected, it is 
called torticollis or wry-neck. In this the head is usually 
drawn to one side, and the patient is unable to turn it 
without turning the body. 

When it is situated in the thoracic muscles it is called 
pleurodynia and may be mistaken for pleurisy or inter- 
costal neuralgia. 



GOUT. 439 

Treatment: Require the patient to remain quiet in 
bed and administer the following: 

Salicylate of Soda (From Oil of 

Wintergreen), 2\ drachms, 

Fl. Ext. of Cimicifuga, 2 drachms, 

Fl. Ext. of Phytolacca Dec, \ drachm, 

Aromatic Elixir, sufficient to make, 2 ounces. 
Mix and give a teaspoonful every three or four hours 
until relieved. Bathe the affected parts freely with the 
White Liniment; or apply cloths wrung out of hot water, 
changing them frequently. Do not allow the bowels to 
become constipated; and if there is scantiness of urine 
give 20 grains of the Acetate of Potash every four hours. 
If there is fever control it with sedatives administered 
according to indications. 

GOUT. 

Gout is a constitutional disease in which there is an 
excess of uric acid in the blood; characterized by the 
sudden occurrence of severe pain, and swelling in one of 
the* smaller joints, usually the great toe, with the deposit 
of the urate of soda in the structure of the joint. There 
are two varieties of the disease; the acute and the chronic. 

The predisposing cause of it is an inherited tendency. 
The exciting causes are the excessive use of wine and 
malt liquors, and high living with indolent habits. 

Symptoms : An attack, though usually preceded for 
a few days by indigestion, lassitude, headache, and 
constipation, commences with a burning, tearing pain 
in the ball of the great toe, which becomes red, hot. 



440 THE PRACTICE OF MEDICINE. 

swollen, and so sensitive that the slightest touch produces 
intense pain. Associated with the pain is a chill, fol- 
lowed by more or less fever, a quickened pulse, thirst, 
and scanty, high-colored, acid urine, which, on cooling, 
deposits a heavy, brick-dust sediment. 

Towards daylight the symptoms ameliorate, but return 
again at night. The disease continues in this manner, 
though, gradually becoming milder, until about the fourth 
or fifth day, when, convalescence is established, the 
patient, as a rule, feeling better than he did before the 
attack. 

An individual may have only one attack, but usually 
a second one supervenes within a year. Gradually the 
attacks approach each other, and become more pro- 
longed, though, less severe, until a condition of chronic 
gout is reached. Deposits now occur, the affected joints 
becoming hard, knotted, and often greatly distorted. 

Treatment: For the acute paroxysms the following 
should be given: 

Salicylate of Soda (From Oil of 

Wintergreen) , 5 drachms, 

Fl. Ext. of Colchicum Seed, 1 drachm, 

Aromatic Elixir, sufficient to make, 4 ounces. 

Mix and give a teaspoonful every three hours until 
the pain is relieved, when, it should be given four times 
a day. 

Fever, when present, should be controlled with 
sedatives administered according to indications; and if 



URTICARIA. 441 

the bowels are constipated Oil, Salts or a Seidlitz Powder 
should be given as is required. 

The pain, when severe should be controlled with \ 
grain doses of the Sulphate of Morphine, preferably, 
hypodermically. 

Hot poultices or cloths wrung out of hot water may 
be applied to the painful part. 

In lingering cases of chronic gout use the following: 

Iodide of Potash, 1 ounce, 

Fl. Ext. of Colchicum Seed, 2 J drachms, 

Aromatic Elixir, sufficient to make,. .6 ounces. 

Mix and give a teaspoonful after each regular meal. 

Where the case becomes chronic from 1 to 2 drachms 
of the Effervescent Citrate of Lithium should be given, 
in half a glass of water, three or four times a day. 

The diet of persons afflicted with gout should consist, 
principally, of vegetables, and fruits, however, tomatoes 
and strawberries should be avoided. Fresh meat may 
be used once a day, as may oysters, fish, and soups. 
Alcoholic and malt liquors must positively be prohibited. 

Flannel should be worn next to the body throughout 
the year, and the skin, kidneys and bowels must be kept 
in a normal condition. 

Moderate exercise in the open air when the weather 
is suitable is very beneficial. 

URTICARIA. 

NETTLE RASH. 

Urticaria is an inflammation of the skin; characterized 
by the appearance of an eruption like the elevations 



442 THE PRACTICE OF MEDICINE. 

produced on the skin by the sting of a nettle, accompanied 
by intense itching and sometimes slight fever. 

The most common causes of it are derangements of 
the stomach and bowels; pregnancy; the" effects of certain 
drugs; malaria; exposure to heat; and the "change of 
life." 

Symptoms: It is such a common affection that it is 
thought a description of it would be superfluous. 

Treatment: The Hydrate of Chloral is almost a 
specific for nettle rash. It may be given in io-grain doses 
every half-hour until it produces quietude or until three 
or four doses have been given. If fever is present, control 
it with sedatives administered according to indications, 
in this as in any other disease. If the bowels are consti- 
pated give a full dose of Salts. 

The Salicylate of Soda in from 3 to 5 -grain doses 
every three hours also acts well in these cases. 

As a local application the following may be used: 

Carbolic Acid, i| drachms, 

Glycerine, \ ounce, 

Alcohol, 4 ounces, 

Camphor- Water, sufficient to make,. . .1 pint. 

Mix and apply to the parts affected with a sponge 
two or three times a day. 

ECZEMA. 

TETTER ; SALT RHEUM. 

Eczema is either an acute or chronic inflammation of 
the skin; characterized by redness, the formation of 
papules, vesicles or pustules, followed by a serous exuda- 



ECZEMA. 443 

tion and the formation of crusts . and intense itching or 
burning. 

There are more than a dozen varieties of eczema, but 
we will have to content ourselves by giving a general 
description of it. 

The causes of it are very obscure; but it is probably 
the result of -an inherited predisposition in many cases. 
The writer believes it to be caused by a microorganism. 

Symptoms: "Eczema is the most common of all 
cutaneous affections, with symptoms varying in accordance 
with the particular variety of the affection and its loca- 
tion, although, the general characteristics of a catarrhal 
inflammation are present in all; these are redness, either 
limited or diffused; heat, of the part affected; swelling, 
the result of serous exudation, giving rise either to a 
discharge (weeping), with subsequent crusting, or to the 
deposition of plastic material. The most constant, 
annoying, and troublesome symptom is the itching, or 
at times burning, which varies from that which is simply 
annoying to that which is almost unendurable." 

" Eczema runs its course either as an acute affection, 
lasting a few weeks, not to return, or to return acutely 
at wide intervals, or, as is much more frequently the case, 
it assumes a chronic state, continuing with more or less 
variations for months, years, or even a lifetime. It may 
appear upon any portion of the body, or involve the 
whole integument (eczema universale)." — Hughes. 

Treatment: Regulate the bowels and kidneys and 
use the following: 



444 THE PRACTICE OF MEDICINE. 

Bichloride of Mercury, 2\ grains, 

Acetic Acid, • . . i drachm, 

Glycerine, i drachm, 

Tr. of Cantharides, sufficient to make, i ounce. 
Mix and apply each night. After the first ounce is 
used the Bichloride of Mercury may be increased to 5 
grains to the ounce; and, as the patient becomes accus- 
tomed to its use, it may be increased, as the patient can 
bear it, to even 20 grains to the ounce. 

In eczema of the palms of the hands the treatment 
should be commenced with 20 grains to the ounce, thus: 

Bichloride of Mercury, 20 grains, 

Acetic Acid, 1 drachm, 

Glycerine, 1 drachm, 

Tr. of Cantharides, sufficient to make, 1 ounce. 
Mix and apply thoroughly to the palms each night 
before going to bed. 

The writer has been very successful in the manage- 
ment of eczema with this plan of treatment. 

TINEA CIRCINATA. 

RING-WORM. 

Ring- worm is a contagious affection of the skin, caused 
by the presence of a vegetable parasite, the trichophyton, 
discovered by Bazin, in 1854. 

It is so common that a description of it is thought to 
be unnecessary. 

Treatment: The same as that recommended for 
eczema. The application of the Tr. of Iodine is efficient, 
so also is the Tr. of Veratrum Viride. 



HERPES ZOSTER. 445 

HERPES ZOSTER. 

SHINGLES. 

Shingles is an acute inflammatory disease ; characterized 
by groups of vesicles upon an inflamed base, situated 
over the course of a nerve, and usually accompanied by 
considerable pain. Its most common seat is over the 
intercostal nerves. 

It is due to an inflammation of the nerve-giangia or 
the nerve trunks, and branches. The causes producing 
this condition are very obscure, but it is generally believed 
to result from cold, injuries to the nerves, anaemia, and 
the medicinal use of arsenic. 

Symptoms : An attack usually commences with neu- 
ralgic pains of a sharp or burning character with more 
or less fever and constipation, followed by the appearance 
of papules, which soon become vesicles. The pain and 
eruption is usually confined to one side of the body but 
may extend to both sides. The vesicles are about the 
size of a pin-head, sometimes larger and are situated on 
a red and highly inflamed base. From the fifth to the 
tenth day, rarely longer, the blisters dry up, leaving 
brownish crusts which drop off in a few days leaving 
scars; and these are sometimes permanent. 

Treatment: Control the fever with sedatives ad- 
ministered according to indications; keep the bowels 
slightly open throughout the attack with Salts; and coat 
the " shingles" with Collodion. 

If the pain is very severe, it may be relieved with 
J-grain doses of Morphine. 



446 THE PRACTICE OF MEDICINE. 

FURUNCLE. 

BOIL. 

A circumscribed, painful inflammation of the skin 
and underlying tissue, beginning in a cutaneous gland, 
terminating in suppuration and the formation of a firm 
central slough or "core." 

They are caused by a pus-producing microorganism, 
which gains entrance through the hair follicles. The 
predisposing causes are . general debility, anaemia, diabetes, 
uraemia, friction or injuries, uncleanliness, contact with 
certain irritants, etc. 

They may occur singly or in crops of two, three or 
more; other crops frequently following their disappear- 
ance. 

Treatment: A boil in its early stage, may sometimes 
be aborted by the use of the following: 

Tr. of Aconite Root, 2-| drachms, 

Tr. of Opium, 2\ drachms, 

Tr. of Arnica, 2\ drachms. 

Mix and apply frequently or keep the part wet with 
it. Should this fail to abort it hot poultices should be 
used until pus is formed, when a free incision must be 
made, to give it exit. Vaseline should now be applied, 
on a soft cloth, for two or three days, to prevent the place 
of exit from closing. 

When a person is afflicted with successive crops 
of boils, relief may usually be obtained from the following: 

Iodide of Potash, i ounce, 

Compound Syr. of Stillingia, to make, 6 ounces. 



ANTHRAX. 44; 

Mix and give a teaspoonful after each regular meal. 
Should this fail | of a grain of the Sulphide of Calcium 
may be given four times a day. 

If the patient is debilitated or anaemic give the fol- 
lowing : 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Aromatic Elixir, sufficient to make, 6 ounces. 
Mix and give a teaspoonful before each regular meal. 

ANTHRAX. 

CARBUNCLE. 

A hardened, gangrenous, deep-seated, more or less 
circumscribed, painful inflammation of the skin and 
subcutaneous cellular tissue terminating in sloughing and 
the subsequent formation of a permanent cicatrix. 

It is caused by a microorganism, the anthrax bacillus. 
The middle-aged and elderly persons are more subject 
to it than others. Men are more frequently attacked 
than women. 

Symptoms: "Carbuncle is recognized by its peculiar 
form; commencing in the lower layers of the cutaneous 
tissue ; it first resembles somewhat a phlegmon minus its 
bright redness. At first, it is somewhat rounded, with a 
strong tendency to the production of vesicles on its surface ; 
soon, however, becoming firm, circular, and flat, and 
raised above the surrounding parts, spreading through 
the subcutaneous tissue and skin, becoming at times 
enormously large, and having a dark, red or violaceous 



448 THE PRACTICE OF MEDICINE. 

color. As the disease progresses, the pressure results 
in the softening of the tissue, the skin becoming gangren- 
ous, breaking down at numerous points, forming per-' 
forations, through which centers of suppuration appear 
in different stages of advancement, either as whitish, 
fibrous plugs, or as cavities, from which a yellowish, 
sanious fluid oozes, the surface of the anthrax having a 
cribriform appearance, perforated like a sieve. The 
entire mass terminates in a slough, which, on being 
detached, leaves a large, open, deep ulcer, with firm, 
everted edges, granulating slowly, a permanent cicatrix 
marking the site of the lesion. The development of the 
carbuncle is attended with severe pain, of a deep, throb- 
bing and burning character." 

"The constitutional symptoms vary with the size, 
number, and severity of the disease; loss of appetite, 
coated tongue, general malaise, and moderate febrile 
reaction accompany all cases, to which are added those 
of septicaemia in severe cases." 

"The duration is from two to six weeks. Its favorite 
site is the back of the neck, shoulders, back, and but- 
tocks. It is usually single." — Hughes. 

Treatment: As soon as its nature is discovered, 
Caustic Potash should be applied to the carbuncle until 
an eschar is fully formed; or several small punctures may 
be made with a bistoury, and small pieces of the Caustic 
Potash inserted well into the diseased tissue. If openings 
have already formed, the Potash may be inserted into 
them and allowed to remain until it is dissolved. Subse- 



WHITLOW OR FELON. 449 

quently the sore should be thoroughly cleansed two or 
three times a day with Peroxide of Hydrogen and then 
dressed with dry Iodoform, the sore being well covered 
with Bichloride Gauze. 

Fever, when present should be controlled with seda- 
tives administered according to indications. If the 
fever assumes a typhoid type treat it as such. Where 
the patient becomes weak stimulants should be given as 
is required. In the absence of fever a good tonic should 
be given if the patient is debilitated. 

WHITLOW OR FELON. 

Whitlow, or felon, is a suppurating inflammation of 
a finger, or, rarely a toe. Its usual location is at the end 
of a finger. The inflammation may commence in the 
membrane covering the bone, or in any tissue between 
this membrane and the skin. 

It is caused by a pus-producing microorganism. The 
predisposing cause is a wound, as a bruise, splinter, etc. 

Symptoms: The first symptom is a slight burning 
pain in the finger, resembling that produced by the 
presence of a small briar. As the disease progresses, 
the part becomes swollen, the pain increases, is throbbing 
n character, and almost unbearable. In the course of 
rom five to ten days suppuration takes place. 

When the inflammation begins in or near the peri- 
osteum, unless proper treatment is adopted, the first 
joint of the bone is apt to be lost. 

Treatment: By adopting the following treatment as 
soon as the nature of the affection is detected a felon may 



450 THE PRACTICE OF MEDICINE. 

be invariably aborted: Examine the finger carefully, to 
determine the most sensitive place; and, when it is found, 
insert, at that place, the point of a narrow-bladed knife 
down to the bone, then, introduce one end of a small 
piece of Iodoform- Gauze to the bottom of the wound 
and allow it to remain thirty-six or forty-eight hours, 
when, it should be removed and the wound dressed with 
dry Iodoform. The cure is now complete, except the 
healing of the wound, which should not, in any case, 
exceed one-fourth of an inch in length. This treatment 
gives much better satisfaction than the old method of 
poulticing, which is now abandoned by our leading 
surgeons. 

SCABIES. 

ITCH. 

Scabies, or itch, is a contagious affection of the 
skin. 

It is caused by the presence of an animal parasite, 
acarus or sarcoptes scabiei. The affection occurs at all 
ages and in all classes. 

Almost every one is familiar with the affection, 
therefore, no description of it is given. 

Treatment: We have never known the following 
treatment to fail to promptly effect a permanent cure: 

Liquid Styrax, 2 ounces, 

Olive Oil, sufficient to make, 6 ounces. 

Mix and apply to the affected part each night, after 
washing thoroughly with soft soap and warm water. 



CLAVUS. 451 

VERRUCA. 

WART. 

A wart is a circumscribed hypertrophy of the papillary 
structure of the skin. Their cause is unknown. 

These growths are usually innocent, but may degenerate 
into cancer. 

Treatment: The following is very efficient: 

Chromic Acid, 1 drachm, 

Water, 1 drachm. 

Mix and apply to each wart with a glass rod or hard 
stick of wood. This turns the wart black, and in a few 
days the whole, or a part, of it drops off. If part of it 
remains another application of the remedy should be 
used. Any of the stronger acids, when used in this manner, 
will remove warts. 

The Tr. of Thuja applied to a wart two or three 
times a day will sometimes remove it. 

The following is highly recommended for the removal 
of, warts : 

Sublimed Sulphur, 5 drachms, 

Concentrated Acetic Acid, 2 \ drachms, 

Glycerine, sufficient to make, 3 ounces. 

Mix and apply to the wart with a brush or on a small 
cloth, each night, washing it off in the morning. The wart 
will turn blue, shrivel, and drop off. 

CLAVUS. 

CORN. 

A corn is a small, circumscribed, usually flat, deep- 
seated hypertrophy of the skin of the foot. There are two 



452 THE PRACTICE OF MEDICINE. 

varieties; the hard, and the soft. The latter may become 
inflamed. The former is not painful only under decided 
pressure. 

It is caused by continued pressure or friction of tight, 
or ill-fitting boots or shoes. 

Treatment: Bathe the foot in warm water twenty 
minutes, then, apply a mush poultice and let it remain 
during the night. This will soften the corn and permit 
of its ready removal with a knife. 

To remove a soft corn apply Carbolic Acid to it with 
a soft, pine stick. A few such applications will remove 
the corn entire. 

The following is also said to be efficient: 

Extract of Cannabis Indica, 3 grains, 

Salicylic Acid, 30 grains, 

Oil of Turpentine, 15 drops, 

Glacial Acetic Acid, 6 drops, 

Hydrochlorate of Cocaine, 6 grains, 

Collodion, sufficient to make, 5 drachms. 

Mix and apply a thin coating over the corn each night, 
putting each coating on top of the preceding one, until 
the corn drops out. 

OTALGIA. 

EAR-ACHE. 

Otalgia, or ear-ache, literally means pain in the ear. 
It is a disease of frequent occurrence, especially in children. 
The affection may be either of a neuralgic or an inflam- 
matory character. 



BURNS AND SCALDS. 453 

The presence of foreign bodies in the ear, and exposure 
to cold and damp are its principal causes. 

Treatment: Apply warm poultices to the ear; or if 
this fails to afford relief use the following: 

Olive Oil, 1 drachm, 

Laudanum, 1 drachm. 

Mix and after warming it drop three or four drops 

into the ear. The common practice of blowing tobacco 

smoke into the ear is beneficial. Should these means 

fail to give relief the Sulphate of Morphine may be given. 

OTORRHCEA. 

Otorrhcea, or running from the ear, is a purulent 
discharge from this organ, usually due to a suppurative 
inflammation of the middle ear, the discharge escaping 
through a perforation in the drum membrane. 

Its most common causes are inflammation and ulcer- 
ation. Those of a scrofulous diathesis are more subject 
to it than others. 

Treatment: Syringe the ear very carefully two or 
three times a day with warm water and Castile Soap, and 
after thoroughly drying the cavity fill it with powdered 
Boracic Acid. This may be accomplished by putting a 
small amount of the powder in the end of a quill and 
placing the quill in the ear and giving it a slight puff 
with the lips only partially closed. 

BURNS AND SCALDS. 

These differ from each other only in the character of 
the heat producing them. When half of the body is 
burned or scalded sufficiently to arrest the function of 



454 THE PRACTICE OF MEDICINE. 

the skin over that extent of surface, death is usually the 
result. When a burn is extensive, the shock to the system 
is severe; the pulse becomes quick and weak and the body 
cold. In very severe cases the patient passes into a stupor 
and soon expires. 

Treatment: Carefully remove the clothing from the 
part, and empty any blisters that may be present by 
puncturing them with a needle. Apply soft cloths, sat- 
urated with a solution of Bicarbonate of Soda, containing 
i ounce to the pint of water. If the pain is severe and 
the pulse weak administer \ of a grain of the Sulphate 
of Morphine, preferably hypodermically. As soon as the 
pain subsides to some extent dress the burned surface 
with the following: 

Carbolic Acid, i J drachms, 

Lime-Water, 8 ounces, 

Olive Oil, 8 ounces. 

Mix and apply on soft linen cloths, or: 

Carbolic Acid, i\ drachms, 

Balsam of Fir, 2 ounces, 

Olive Oil, sufficient to make, 6 ounces. 

Mix and use as a dressing twice a day. If the surface 
is covered with pus it should be removed with Peroxide 
of Hydrogen before applying the dressing. 

The following also makes an excellent dressing for 
burns : 

Gum Camphor, \ ounce, 

Carbolic Acid, i ounce, 

Alcohol, \ ounce, 



INCISED WOUNDS. 455 

Glycerine, J ounce, 

Olive Oil, sufficient to make, 1 pint. 

Mix and use as the preceding. 

When the pulse is weak stimulants such as Whiskey, 
Aromatic Spirits of Ammonia, and the Sulphate of 
Strychnine should be used. 

Regulate the bowels with the Fl. Ext. of Cascara 
Sagrada, and if the patient has fever control it with 
sedatives administered according to indications. Should 
symptoms of septicaemia occur appropriate treatment for 
this condition must be adopted. 

INCISED WOUNDS. 

cuts. 

The first thing that demands our attention in this 
class of wounds, is the hemorrhage, which, when a 
considerable sized artery, or vein, is severed, can only 
be permanently controlled by grasping the end of the 
divided vessel with a pair of artery forceps and apply- 
ing a ligature around it. The hemorrhage from small 
arteries and veins may be controlled by simply grasping 
their divided ends with the artery forceps and twisting 
them. Of course, the unprofessional are not supposed 
to be prepared for such emergencies, therefore, we will 
give directions for controlling hemorrhage, temporarily, 
until the services of a surgeon can be obtained. If the 
bleeding vessel is an artery, and this may be known by 
the blood's being of a bright-red or scarlet color and 
flowing in jets or spurts, tie a bandage around the limb 
between the wound and the heart and draw it sufficiently 



456 ' THE PRACTICE OF MEDICINE. 

tight to check the hemorrhage; or if it is a vein, and this 
may be known by the blood's being of a dark-red, or 
purple color, and flowing in a continuous stream, tie a 
bandage around the limb, between the wound and ex- 
tremity, drawing it sufficiently tight to check the hem- 
orrhage. 

After the hemorrhage is permanently controlled, the 
following should be used: 

Bichloride of Mercury, 7 J grains, 

Citric Acid, 4 grains, 

Water, recently boiled, 1 quart. 

Mix and irrigate the wound thoroughly, then, dust it 
with Iodoform and close ' the wound with sutures or 
adhesive strips, after which, dust with the Iodoform and 
then carefully cover with Bichloride Gauze, and on top 
of this place plenty of absorbent cotton and then carefully 
bandage. Do not remove the dressing for several days 
unless the wound becomes swollen or painful. If pus 
appears in the wound cleanse it with Peroxide of Hydrogen 
and dress as above, beginning with the Bichloride wash. 

CONJUNCTIVITIS. 

"common sore eyes." 

This is an inflammation of the conjunctiva, a delicate 
membrane lining the eyelids and covering part of the 
eye-balls, either of an acute or chronic character. When 
chronic there may be more or less granulation of the lids, 
especially in those of a scrofulous diathesis. 

The usual causes of " common sore eyes" are slight 
injuries to the eyes; contact with some foreign body; 



CONJUNCTIVITIS. 457 

exposure of the eyes to dust; strong vapors; smoke; or 
very cold wind, etc., etc. 

Treatment: In acute cases, require the patient to 
remain in-doors; keep the bowels slightly open with Salts; 
and use the following: 

Boracic Acid, 10 grains, 

Rose-Water, i ounce. ■ 

Mix and use as an eye-water every two or three 
hours, or: 

Sulphate of Zinc, i\ grains, 

Sulphate of Morphine, 2 grains, 

Rose-Water, 1 ounce. 

Mix and use as the preceding, or: 

Sulphate of Zinc, 1 \ grains, 

Acetate of Lead, 2 grains, 

Sulphate of Morphine, 2 grains, 

Rose-Water, 1 ounce. 

Mix and use as the preceding, or: 

Sulphate of Cadmium, 1 grain, 

Sulphate of Morphine, 2 grains, 

Rose-Water, 1 ounce. 

Mix and use as the preceding. All these formulas 
make good eye-waters, however, for general use the first 
named is probably the most efficient. 

In chronic cases, in addition to the use of one of the 
foregoing eye-waters, the treatment recommended for 
scrofula should be given; and if the lids are granulated 
they must be penciled two or three t'mes a week with 
Blue Stone. 



458 THE PRACTICE OF MEDICINE. 

The wash containing the Sulphate of Cadmium is said 
to be efficient in removing spots from the eyes. 



PART IX. 

DISEASES OF WOMEN INCLUDING DIRECTIONS 

FOR THE MANAGEMENT OF NATURAL 

LABOR, ETC. 

Females are subject to numerous diseases peculiar to 
their sex, but we shall confine ourselves principally to 
those that may be successfully treated without the aid of 
a physician. 

MENSTRUATION, 

Menstruation is a function, which is usually established 
between the twelfth and fifteenth years of age, and recurs, 
except when interrupted by pregnancy or disease about 
every twenty-eight days until the female reaches the age 
of about forty-five years. The first appearance of the 
menses or monthly sickness is usually preceded by the 
discharge of a whitish fluid from the vagina; by nervous 
excitement and vague pains and heaviness in the loins 
and thighs; numbness of the limbs, tumefaction of the 
breasts, etc. More or less indisposition and irritability 
precede each return of the flow. In temperate climates 
each period usually continues from three to six days; and 
the quantity of blood lost varies from three to eight ounces. 
The appearance of the menstrual discharge is usually 

459 



4<5o THE PRACTICE OF MEDICINE. 

indicative of the maturity of the female, and her capability 
of becoming a mother; while its cessation manifests a loss 
of such capability. 

Menstruation is supposed to result from a congestion 
of the womb, which always attends the escape of the ova 
or eggs, from the ovaries. 

Mothers should inform their daughters of this change 
before it takes place, and also caution them against 
exposure to cold, damp, excessive heat, etc. Many serious 
troubles arise on account of a neglect of this important 
duty by mothers. 

The departures from healthy menstruation are 
numerous, though the most important of these are 
amenorrhcea, dysmenorrhoea, and menorrhagia. 

AMENORRHEA. 

ABSENT OR SUPPRESSED MENSTRUATION. 

By amenorrhcea is meant the non-appearance of the 
menses at the age of puberty, or its suppression after it 
has once occurred. In weak and debilitated girls, or 
those who are undeveloped, no special symptoms 
are present to indicate menstrual derangement. Well- 
developed, full-blooded girls, where their menses do not 
appear at the proper age, suffer from headache, a sense 
of fullness in the head, and have more or less pain in 
the lower part of the bowels and in the back. Cases 
occasionally occur where there are " bearing-down " 
sensations resembling the first pains of labor. 

Suppression of the menses may occur suddenly, as a 
result of cold taken during the menstrual' period, from 



AMENORRHEA. 461 

getting the feet or body wet; sitting on the damp ground; 
cold applied to the vulva; exposure to excessive heat; 
severe mental emotions just preceding or during the 
menstrual flow; sexual intercourse during menstruation; 
and from fever, or other acute diseases commencing at 
the time of the periods, or the suppression may come on 
gradually, as a sequence of any chronic disease, which 
produces debility of the general system. Sudden sup- 
pression is attended by symptoms similiar to those seen 
in the full-blooded, as a result of the non-appear- 
ance of the menses, only it is often accompanied by 
marked fever. The habitual use of Opium or Morphine 
is usually attended by a suppression of the menses. In 
these cases the patient has the characteristic appearance 
of the "opium-eater." 

Treatment: In all cases of absent menstruation, 
where the general health is unimpaired, no treatment 
whatever should be employed; it is only where the health 
suffers, in these cases, that the aid of medicine is required. 
The health of many females has been ruined for life by 
the injudicious use of remedies to force the menstrual 
flow. 

If the patient is weak and debilitated the treatment 
must be directed towards toning up the general system, 
and increasing the quality and quantity of blood. For 
this purpose we possess nothing more efficient than the 
following : 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 



462 THE PRACTICE OF MEDICINE. 

FL Ext. of Cimicifuga, 1 J ounces, 

Fl. Ext. of Pulsatilla, 3 drachms, 

Aromatic Elixir, sufficient to make,. .6 ounces. 
Mix and give a teaspoonful before each regular meal. 
If the bowels are constipated they should be well regulated 
with the Fl. Ext. of Cascara Sagrada. The patient should 
take moderate exercise each day in the open air. 

Some females never menstruate on account of a 
malformation of the parts, such as the absence of the 
ovaries, etc.; while in others, the discharge does not make 
its appearance on account of an imperforate hymen. 
Of course, the first-named condition is not amenable to 
treatment, but the latter may be relieved by making a 
small incision through the hymen. 

When amenorrhoea occurs as a result of exposure > or 
other imprudence, require the patient to take a warm 
sitz-bath each night just before and during the time the 
catamenia should have occurred; and also administer 
from 5 to 10 drops of the Oil of Pennyroyal immediately 
after each bath is taken. Should these means fail, from 
30 to 45 drops of the Fl. Ext. of Gossypium may be given 
every four hours. The following is, also efficient in these 
cases : 

Fl. Ext. of Pulsatilla, 3 drachms, 

Fl. Ext. of Cimicifuga, i\ ounces, 

Fl. Ext. of Caulophyllum, 1 J ounces, 

Aromatic Elixir, sufficient to make, 6 ounces. \ 
Mix and give a teaspoonful three times a day before 
meals. 



DYSMENORRHEA. 463 

Should fever occur control it with sedatives administered 
according to indications. 

DYSMENORRHEA. 

PAINFUL MENSTRUATION. 

Where the menstrual flow is preceded or attended by 
severe pain, the condition is known as dysmenorrhcea, 
or painful menstruation. The pain is usually caused 
by the retention of the discharge in the womb, and the 
efforts of nature to expel it. It may be due to anteflexion, 
retroflexion, congestion of the neck of the womb, or an 
abnormal constriction of the mouth of the womb, either 
one of which prevents the ready passage of the menstrual 
discharge. 

Treatment: If the bowels are constipated administer 
from 10 to 30 drops of the Fl. Ext. of Cascara Sagrada 
before each regular meal, either increasing or diminishing 
the dose according to its effects on the bowels. For 
the purpose of relieving the pain during the periods from 
2 to 5 drops of the Fl. Ext. of Gelsemium should be given 
every hour or so until easy. 

With a view of making a permanent cure the 
following may be tried: 

Fl. Ext. of Phytolacca Dec, 2 \ drachms, 

Fl. Ext. of Cimicifuga,. i\ ounces, 

Fl. Ext. of Pulsatilla, 3 drachms, 

• Fl. Ext. of Gelsemium, 3 drachms, 

Aromatic Elixir, sufficient to make, 6 ounces. 

Mix and give a teaspoonful three times a day, before 
meals. This should be used for three or four months. 



464 THE PRACTICE OF MEDICINE. 

Should it finally fail to afford relief, a competent physician 
should be consulted. 

MENORRHAGIA. 

PROFUSE MENSTRUATION. 

By menorrhagia, or profuse menstruation, is meant 
an excessive flow of blood at the menstrual periods. 
When a flow of blood occurs during the interval between 
the periods, the condition is called metrorrhagia. The 
treatment of these conditions are the same, therefore a 
separate notice of them is not given. 

These conditions may be caused by debility of the 
general system, relaxation, or enlargement of the womb, 
general plethora, polypi, fibrous tumors, retained 
products of conception, etc., etc. 

Treatment : Require the patient to remain quiet in 
bed and if the bowels are constipated regulate them with 
the Fl. Ext. of Cascara Sagrada. 

With a view of checking the flow of blood the follow- 
ing should be given: 

Spirits of Cinnamon, i\ ounces, 

Fl. Ext. of Ergot, sufficient to make, 4 ounces. 

Mix and give from \ to 1 teaspoonful, in a sup of water 
every two or three hours until the hemorrhage is checked 
or until the remedy has been given a thorough trial. 

Where the hemorrhage is the result of tumors or the 
retained products of conception these will have to be 
removed before a cure can. be effected. 

Where the patient is debilitated the following tonic 
should be given: 



THE MENOPAUSE. 465 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis, 1 ounce, 

FL Ext. of Gentian, 3 ounces, 

Fowler's Solution of Arsenic, i\ drachms, 

Aromatic Elixir, sufficient to make, 6 ounces. 

Mix and give a teaspoonful before each regular meal. 

Should these means fail to effect a cure consult, a 
competent physician. • 

THE MENOPAUSE. 

" CHANGE OF LIFE." 

The cessation of menstruation or " change of life" 
usually occurs after the menstrual function has been per- 
formed about thirty years, or about the forty-fifth year 
of life. In some it occurs earlier and in others later than 
just stated. It is always looked upon by females with 
some degree of anxiety. 

Symptoms: In healthy females the cessation of 
menstruation is not generally attended by any impair- 
ment of the general health, the discharge either assuming 
a pale color and diminishing gradually, or terminating 
in a profuse discharge, the function, afterwards, being 
suspended for the remainder of life. Not infrequently, 
in these cases, the breasts and abdomen enlarge and 
sometimes the female imagines that she is pregnant. 

In delicate females, and those who have suffered from 
previous diseases of menstruation, it is not uncommon to 
meet with excessive menorrhagia, or profuse uterine 
hemorrhage, jeopardizing the patient's life. The symp- 
toms in these cases, vary considerably, however, there is 



466 THE PRACTICE OF MEDICINE. 

usually more or less pelvic irritation, with a bearing-down 
sensation ; a frequent desire to urinate ; heat and tenderness 
of the vagina, and itching of the vulva. 

Various diseases, such as vertigo, hysteria, colic, 
hemorrhoids, ulcers of the legs, dyspepsia, apoplexy, cancer 
of the womb, etc., etc., are liable to be developed at this 
period. ' 

Treatment: Avoid exposure to cold and damp; 
keep the skin clean ; adopt a light, nutritious diet, and if 
the bowels are constipated, regulate them with the Fl. 
Ext. of Cascara Sagrada. 

If the patient is pale and anaemic give the following: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Fowler's Solution of Arsenic ij drachms, 

Aromatic Elixir, sufficient to make, . 6 ounces. 

Mix and give a teaspoonful before each regular meal. 

Should a profuse hemorrhage occur from the womb, 
require the patient to assume the recumbent position 
and remain perfectly quiet; lower the head and shoulders; 
apply cloths wrung out of cold water to the vulva and 
lower part of the bowels; and administer from \ to 1 
teaspoonful of the Fl. Ext. of Ergot, every half-hour or 
hour as the urgency of the case demands. Should these 
means fail to control the hemorrhage, call a competent 
physician, who may use a tampon. Where complications 
arise they should be treated as original affections. 



CHLOROSIS. 467 

CHLOROSIS. 

GREEN SICKNESS. 

Chlorosis, or green sickness, is a pronounced anaemia 
occurring in young girls about the age of puberty. It is 
a disease in which there is a deficiency of red-blood 
corpuscles usually associated with the non-appearance or 
suppression of the menses. Its causes are not understood. 
Symptoms: Its principal symptoms are a peculiar, 
waxy, yellowish, or greenish pallor of the face ; pale tongue ; 
almost colorless lips; and in some cases, oedema, or 
pumness of the feet and ankles or the face; and a dark 
circle may appear around each eye. The patient is weak 
and nervous; there is palpitation of the heart; and the 
temperature of the body is slightly below normal. Diges- 
tion is impaired, and a morbid appetite is sometimes 
present, as for slate-pencils, chalk, dirt, etc. 

Treatment: This should be commenced by the ad- 
ministration of the following tonic: 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can., 1 ounce, 

Fl. Ext. of Gentian, 3 ounces, 

Fowler's Solution of Arsenic, .. .ij drachms, 
Aromatic Elixir, sufficient to make, 6 ounces. 
Mix and give a teaspoonful before each regular meal. 
Iron is strongly indicated in these cases, but the writer 
has never had much benefit follow its administration, 
however, should the reader wish to give it, the Dialyzed 
Iron, in 20-drop doses four times a day, is the best form 
of it. 



468 THE PRACTICE OF MEDICINE. 

If there is oedema or pumness of any part of the 
body 3 or 4 drops of the Fl. Ext. of Apocynum Can- 
nabinum should be given four times a day. 

If the bowels are constipated regulate them with the 
Fl. Ext. of Cascara Sagrada. 

The patient's diet should be of the most nutritious 
character, and moderate exercise should be taken each 
day in the open air. 

LEUCORRHCEA. 

"whites." 

By leucorrhoea, of " whites" is meant a whitish or 
yellowish discharge from the vagina or womb, resulting 
from irritation or inflammation of the lining membrane 
of the vagina or womb. 

The principal causes of leucorrhoea are excessive 
coition, frequent abortions, or child-bearing, masturbation, 
mechanical injuries and exposure to cold and damp. 

Symptoms: These, in addition to the discharge, are 
pain and a sense of heaviness in the loins, abdomen 
and thighs; disorders of digestion; impairment of the 
general health; and, in some cases, more or less oedema, 
or swelling of the feet and ankles. When the disease 
is allowed to continue any considerable time, ulcers are 
apt to appear on, or about the mouth of the womb, causing 
the discharge to be tinged or streaked with blood. The 
discharge is sometimes so acrid that it excoriates the 
parts over which it flows. Hysteria is often an attendant 
of leucorrhoea. 



LEUCORRHCEA. 469 

Treatment: The patient usually needs a tonic, and 
we know of nothing better than the following: 

Fl. Ext. of Cimicifuga, 1 J ounces, 

Fl. Ext. of Nux Vomica, 3 drachms, 

Fl. Ext. of Hydrastis Can.,. 1 ounce, 

Aromatic Elixir, sufficient to make, . 6 ounces. 
Mix and give a teaspoonful before each regular meal. 
If the feet and ankles are swollen, 3 or 4 drops of the Fl. 
Ext. of Apocynum Cannabinum should also be given four 
times a day. If the bowels are constipated, they must 
be regulated with Cascara Sagrada. 

The use of the following must not be neglected in 
these cases: 

Bichloride of Mercury, 15 grains, 

Citric Acid, 15 grains, 

Water, 1 quart. 

Mix and use as an injection each night after injecting 
a half-gallon of water as hot as can be borne, or: 

Sulphate of Zinc, 4 drachms, 

Water, 1 quart. 

Mix and use as the preceding. 

If the mouth of the womb is ulcerated, the ulcers should 
be painted with Tr. of Iodine two or three times a week. 
To accomplish this it will be necessary to use a speculum. 
Where the womb is enlarged, not only in leucorrhcea, 
but in any other disease, saturate a roll of absorbent cotton, 
four or five inches long and three-fourths of an inch in 
diameter, with pure Glycerine, attach a silk cord to its 
center and pack it well up around the mouth of the 



47o THE PRACTICE OF MEDICINE. 

womb, allow it to remain twenty-four hours, when, it 
should be removed and from a half to a gallon of water, 
as hot as can be borne, used as an injection. These 
applications should be used two or three times a week 
until the enlargement is reduced. 

VAGINITIS. 

INFLAMMATION OF THE VAGINA. 

Vaginitis is an inflammation of the mucous membrane 
lining the canal leading from the vulva to the womb, 
characterized by more or less fever, pain, heat, and burn- 
ing of the parts, with a yellowish-colored discharge, which 
is sometimes so acrid that it excoriates the external parts. 

The most common causes of vaginitis are cold, injuries 
to the vagina, and excessive sexual intercourse. 

Treatment: Require the patient to assume the 
recumbent position and remain perfectly , quiet ; and if 
she has fever, control it with sedatives administered 
according to indications. Keep the bowels slightly open 
with Salts; and during the acute stage of the disease, a 
quart of warm water, containing 2 or 3 drachms of the Tr. 
of Opium, should be injected into the vagina every three 
or four hours. The external application of cloths wrung 
out of hot water affords some relief, therefore, their use 
should not be neglected. 

As soon as the more acute symptoms have subsided, 
the mouth of the womb and vaginal walls should be thor- 
oughly cleansed and a tampon of cotton saturated with 
Carbolized Glycerine applied so as to prevent all contact 
of the opposing walls. This should be renewed each 



VULVITIS. . 471 

twenty-four hours. It prevents morbid adhesion of the 
parts, therefore, its use is important. 

PRURITUS VULV.E. 

ITCHING OF THE VULVA. 

By pruritus vulvae, or itching of the vulva, is meant 
an intolerable itching of the external organs of generation 
in the female. 

The causes of it are very obscure. 
Treatment: The following is generally efficient in 
these cases: 

Carbolic Acid, 20 drops, 

Sulphate of Morphine, 9 grains, 

Borax, 6 drachms, 

Rose-Water, sufficient to make, 6 ounces. 

Mix and apply to the parts frequently. Keep the 
bowels slightly open with Salts. 

VULVITIS. 

INFLAMMATION OF THE VULVA. 

This is an inflammation of the external organs of 
generation in the female; characterized by heat, pain, 
swelling, and more or less excoriation of the parts, with, 
in some cases, the formation of an abscess, or small ulcers 
on the affected parts. 

It is usually caused by uncleanliness, or an injury, 
such as a fall or blow. 

Treatment: Apply cloths wrung out of hot water 
to the parts, changing them frequently; keep the bowels 
moderately open with Salts; and if fever is present, 
control it with sedatives administered according to indi- 



472 THE PRACTICE OF MEDICINE. 

cations. Should an abscess form, the pus should be evac- 
uated, by means of an incision, at once. 

FLEXION, VERSION, AND PROLAPSUS OF THE 

WOMB. 

When the womb falls forward the neck being bent 
upon itself, the condition is called Anteflexion; when it 
falls backward, the neck being bent upon itself, 
the condition is called Retroflexion. When the womb 
falls forward without being bent upon itself, the condi- 
tion is called Anteversion; when it falls backwards against 
the rectum, without being bent upon itself, the condi- 
tion is called Retroversion; and when the womb drops 
down in the vagina, the condition is called Prolapsus, or 
falling of the womb. 

Treatment: If the womb is enlarged the Glycerine 
tampons recommended in leucorrhcea will sometimes 
effect a cure, however, in these cases it would be advisable 
to consult a competent physician. 

SIGNS OF PREGNANCY. 

The principal signs of pregnancy are a cessation of 
menstruation; morning sickness; a darkening of the circle 
around the nipples; yellowish or brownish, colored spots 
on the skin, especially on the face and breasts; more or 
less incontinence of urine; acidity of the stomach; an 
excessive secretion of saliva; a tendency to syncope; 
enlargement of the abdomen; and quickening, or move- 
ment of the child, which is the most positive sign. The 
majority of the foregoing symptoms may be present and 



DISEASES OF PREGNANCY. 473 

yet the female not be pregnant, or she may be pregnant 
and have but few of these symptoms. 

DISEASES OF PREGNANCY. 

The principal diseases of pregnancy are morning 
sickness, acidity of the stomach or heart-burn, toothache, 
oedema or pumness of the feet and ankles, and consti- 
pation of the bowels. 

MORNING SICKNESS. 

This may usually be relieved by requiring the patient 
to take a light breakfast an hour before arising in the 
morning. Should this fail, 5 to 10 grains of the Oxalate 
of Cerium may be given three or four times a day. In 
some cases it is necessary to terminate the pregnancy 
in order to prevent the patient's starving. See Irritation 
of the Stomach. 

CONSTIPATION. 

See Constipation of the Bowels. 

CEDEMA, OR SWELLING OE THE FEET AND ANKLES. 

This may usually be checked or relieved with 3 or 4 
drops of the Fl. Ext. of Apocynum Cannabinum admin- 
istered four times a day. 

TOOTHACHE. 

This may usually be overcome with Lime-Water. 
An ounce of it should be given in sweet milk three or four 
times a day. See Toothache. 

HEART-BURN. 

This may usually be relieved with from 5 to 10-grain 
doses of the Subnitrate of Bismuth, administered oc- 
casionally as the urgency of the case demands. Instead 



474 THE PRACTICE OF MEDICINE. 

of the Bismuth 20 to 30 grain doses of the Carbonate of 
Magnesia may be given. 

ABORTION. 

By abortion is meant the expulsion of the embryo or 
foetus before the seventh month of pregnancy. When it 
occurs after this time it is called a miscarriage or prema- 
ture labor. 

The most common causes of abortion and miscarriage 
are the lifting of heavy weights, worry, excitement, exces- 
sive grief, falls, blows, the eruptive fevers and a syphilitic 
taint of one or both parents. 

Symptoms: Intermittent pains in the back, extend- 
ing into the lower part of the bowels, and more or less 
hemorrhage from the womb, are about the only symptons 
of any importance. 

Treatment: Require the patient to assume the 
recumbent position and remain quiet; and administer 
a I of a grain of the Sulphate of Morphine and if 
the patient is not easy in an hour repeat the dose. 

With a view of controlling the hemorrhage cloths 
wrung out of cold water should be applied to the vulva, 
changing them frequently. Should these means fail to 
afford relief call a competent physician at once. 

As soon as the pain subsides give a teaspoonful of the 
Fl. Ext. of Black Haw three times a day before meals. 

In addition to the foregoing, if the patient is syphilitic, 
the following should be given: 

Bichloride of Mercury, 1| grains, 

Iodide of Potash, 1 ounce, 



LABOR; PARTURITION. 475 

Water, sufficient to make, 6 ounces. 

Mix and give a teaspoonful after each regular meal. 

LABOR; PARTURITION. 

CONFINEMENT OR CHILD-BIRTH. 

Labor, parturition, confinement, or child-birth, is the 
expulsion of the foetus, after-birth, etc., at full term. 
This occurs at the end of nine calendar months and one 
week, or about two hundred and eighty days from the 
last menstruation, and about one hundred and forty days 
after quickening or the first movements of the child. 
Labor may occur a few days earlier, or a few days later, 
than the time just stated. "The process of labor is 
accomplished by the contractions of the womb, assisted, 
in the latter stage, by contractions of the muscles of the 
abdomen. The time occupied in the process, varies 
considerably; but on an average, it continues from three 
to six hours; and more children are born between sunset 
and sunrise than during the day, in the proportion of 
ten to seven." 

"The principal symptoms of approaching labor is a 
settling down of the womb, which relieves the female 
very much, causing her to have a lighter feeling, to 
breathe more freely, to be in better spirits, and to move 
more actively than for two or three months before. Not 
infrequently, there will be a constant desire to evacuate 
the bowels or bladder. A flow of bloody mucus also 
takes place in most instances, called ' the show; ' 
and flying pains in the back and loins, wakefulness, 
nervous excitability, etc., are apt to be present. Some- 



476 THE PRACTICE OF MEDICINE. 

times, owing to constipation, great weariness, rheuma- 
tism, etc., a kind of pain will be felt in the latter weeks 
of pregnancy, which are termed 'false pains,' and which 
may be determined from true pains, by observing that 
the latter commonly begin in the back, and spread around 
the bowels, in the region of the womb, that they come 
on regularly, with intervals of freedom from pain, and 
that they acquire more severity, as well as frequency, 
with the advance of labor. If during their presence 
pressure with the hand be made upon the bowels so as 
to feel the womb, this organ will be felt firm, hard, and 
contracting, somewhat like a hard tumor, becoming soft 
as the pain ceases." — King. 

Labor is divided into four varieties; natural labor; 
protracted, tedious, or difficult labor; preternatural labor; 
and complicated labor. 

Labor is said to be natural when the child's head 
presents so as to be the first part born, and where the 
process of expulsion does not exceed twenty-four hours, 
being completed by the unaided efforts of nature, or with 
the aid commonly bestowed. 

By protracted, tedious, or difficult labor, is meant the 
same as the preceding, with the exception that the process 
of expulsion exceeds twenty-four hours, and the patient 
may need some kind of artificial aid before it can be 
completed, as the use of Ergot, instruments, etc. 

Labor is said to be preternatural when any other part 
of the child presents at the mouth of the womb except 
the head; where the cord or navel-string falls down so as 



LABOR; PARTURITION. 477 

to show itself on the outside when the waters break, and 
where there are two or more children. 

When labor is accompanied by convulsions, severe 
hemorrhage, etc., it is called complicated. 

Natural labor is divided into three stages; First, 
Second and Third. 

The first stage continues until the mouth of the womb 
becomes thoroughly dilated or opened, which, may 
usually be known by the rupturing of the membranes, 
and the discharge of the waters or amniotic fluid. 

The second stage of labor continues from the complete 
dilatation of the mouth of the womb or discharge of the 
waters, until the birth of the child is completed. 

The third stage of labor continues from the birth of 
the child until the after-birth is expelled. 

During the first stage of labor there are severe, cutting, 
grinding, or sawing pains in the back, extending to the 
loins, the front of the abdomen and pubes, and termin- 
ating in the groins or upper part of the thighs. They 
usually occur regularly at intervals of ten to twenty 
minutes, increasing in frequency and severity as the labor 
advances, the female being almost entirely free from pain 
during the intervals. Flashes of heat and cold, with a 
frequent desire to evacuate the bowels and the bladder 
are usually present. Towards the latter part of this stage 
there is usually vomiting; or each pain may be ushered 
in with slight shivering. If an examination is now made, 
during the presence of a pain, the "bag of waters" will 
be found tense and protruding from the mouth of the 



47B THE PRACTICE OF MEDICINE. 

womb into the vagina; but as the pain subsides it becomes 
lax and recedes into the uterine cavity. Finally when 
the mouth of the womb is completely dilated, the patient 
has a severe pain and the membranes are ruptured, the 
waters rushing out with a gush and the first stage of labor 
is at an end. 

After a longer or shorter period of freedom from pain, 
the second stage of labor is ushered in. The pains 
continue as in the preceding stage, only they are more 
regular and of an expulsive or bearing-down character, 
the female fixing her feet firmly upon some immovable 
point then fills her chest with air, closes her mouth, grasps 
at any object within her reach, and forcibly strains or 
bears down. 

Upon making an examination, the child's head will be 
found in the pelvic cavity, each pain forcing it towards, 
or upon the perinseum, which finally becomes thin and 
greatly distended, when during a succession of strong, 
expelling pains, called double pains, the head is born, 
while at the same time the female usually utters a sharp, 
agonizing shriek, which is generally followed by sobbing, 
and after a short period of repose, the remainder of the 
child is expelled. As soon as the child's head is born, 
it frequently commences breathing and crying, or if this 
does not immediately occur, it will, usually as soon as the 
mucus is removed from its mouth. 

After the delivery of the child, the female enjoys a 
greater or less period of repose, until the third stage of 
labor commences, when the pains return, but with less 



MANAGEMENT OF NATURAL LABOR. 479 

severity than before, and usually after two or three have 
been experienced the after-birth is expelled. Sometimes 
the after-birth is delivered with the same pain that expelled 
the child, however, in a majority of cases, from a few 
minutes to a half-hour elapses before this takes place. 

MANAGEMENT OF NATURAL LABOR. 

The management of labor should not be undertaken, 
when it can possibly be avoided, by any one, who is 
incompetent to treat any or all complications that may 
arise, as the health, and frequently the life of both mother 
and child is sacrificed by the incompetency of the attend- 
ant; and if it were not for the fact that it is sometimes 
impossible to procure the services of a competent attendant 
at the proper time, the subject would not have been given 
a place in this work. 

During the first stage of uncomplicated labor the 
female need not be confined to bed, but the bowels and 
bladder should be thoroughly evacuated. In some cases, 
especially when the bowels are constipated, an enema 
of warm soap-suds should be given every half -hour or so, 
until the bowels move freely, and if the patient is unable 
to void her urine, the bladder must be emutied by means 
of a soft rubber-catheter. 

When the pains are regular, and rather frequent, an 
examination should be made to ascertain the condition 
of the parts, the progress of the labor, and whether the 
presentation is normal or otherwise. Before making the 
examination the hands should be thoroughly washed 
with warm water and soap, the nails thoroughly cleaned, 



480 THE PRACTICE OF MEDICINE. 

after which the hands should be bathed in i to 500 
Bichloride solution (1 grain to the ounce) and then anointed 
with Vaseline or Lard. The examination should be 
made during the presence of a pain, care being used, 
however, not to rupture the membranes. 

If it is a head presentation, the round mass of the 
cranium is at once felt through the lower part of the 
uterus, but the presentation cannot be positively deter- 
mined, as a rule, until the membranes are ruptured, 
which should occur as soon as complete dilatation of the 
mouth of the womb is completed. Should nature fail 
to perform this duty, at the proper time, it may be accom- 
plished by pressing on the membranes, during a pain, 
when they are rendered tense, with some pointed instru- 
ment, such as the end of a hair-pin, which is always at 
hand; or, what is better, a notch may be made in the 
finger-nail, and, during the presence of a pain, a sawing 
motion should be made on the membranes. Previous 
to rupturing the membranes, the patient's bed should 
be prepared, and she should be required to maintain the 
recumbent position, not allowing her to assume the erect 
posture under any pretense, during the remainder of labor. 

As soon as the membranes are ruptured, the second 
stage of labor is ushered in. The patient should now 
be required to lie upon the back, with the legs semi-flexed, 
two attendants being present constantly, one on each side 
of the bed, to give support to the knees, and hold the 
hands during each pain. The patient must be instructed 



MANAGEMENT OF NATURAL LABOR. 481 

to hold her breath during these expulsive efforts, and to 
remain as quiet as possible in their absence. 

A vaginal examination should be made from time to 
time, though, not too often, to determine the progress 
of the labor. The patient's clothing should consist of a 
light gown, which should be tucked up under the 
shoulders to prevent its being soiled. This should be 
attended to before the waters break. 

As soon as the head begins to distend the perinaeum, 
the attendant should keep a finger on it so as to support 
the parts at the proper time, which is, as the head emerge 
from the vulva. This is accomplished by placing the palm 
of the hand over the perinaeum and making gentle pres- 
sure upwards and forwards. The pressure should only 
be made while a pain is present, however, the parts should 
be supported at this stage in the absence of a pain. It 
is also necessary to support the perinaeum while the shoul- 
ders are being born. As soon as the head is expelled, 
the attendant should pass a finger around the neck of 
the child, and if it be embraced by one or more turns of 
the umbilical cord, it must be liberated by loosening it, 
and passing it over the head; and a finger should also 
be passed into the child's mouth, to remove any mucus 
that may be present. 

The first duty of the attendant after the child is born, 
is to examine the lower part of the mother's abdomen, 
to ascertain the condition of the womb. If it has contracted, 
a hard, spherical knot will be felt, and, if it has not con- 



482 THE PRACTICE OF MEDICINE. 

tracted, the abdomen should be kneaded until contraction 
occurs. 

The attention should now be turned to the child. If 
it is breathing properly, the cord should be securely tied 
with a soft cotton or silk cord, an inch and a half or two 
inches from the child's body, being careful not to include 
any portion of a protruding intestine. Another ligature 
should also be placed around the cord two inches from 
the first one, towards the placental extremity. The cord 
may now be severed with a pair of sharp scissors, between 
the two ligatures, and the child passed to the nurse, who 
should anoint its entire body with common lard or 
Vaseline, and then thoroughly wash it with warm water 
and a good quality of toilet soap. 

If the child fails to breathe, when first born, cold water 
may be sprinkled upon its head and breast. Should 
this not accomplish the desired result, artificial respi- 
ration must be resorted to. This consists of raising the 
arms above the head and bringing them down by the 
sides once every four or five seconds, making slight pres- 
sure on the breast while the arms are being brought down. 
Where these means fail to produce respiration, a small 
hole should be cut in a thick piece of cloth, which should 
be placed over the baby's mouth. The attendant, holding 
the baby's nose, should now apply her mouth to that of 
the baby and inflate its lungs with air, which should be 
gently pressed out and the lungs inflated again as before. 
Should this fail to produce respiration, the cord may be 
tied and severed at once, and the baby's entire body 



MANAGEMENT OF NATURAL LABOR. 483 

placed in a warm bath, being careful however, not to 
allow its mouth and nose to be covered with water. 

If after giving the proper attention to the child, the 
after-birth is not expelled, the abdomen should be kneaded, 
making gentle pressure downwards upon the womb. 
Should this fail to effect its expulsion very light traction 
may be made upon the cord during a contraction of the 
womb. This is accomplished by wrapping the cord 
around the fingers of the left-hand and introducing two 
fingers of the right-hand into the vagina, and holding 
the cord with the left-hand and making slight traction 
downward and backward by pressing on the cord with 
the fingers that are in the vagina. If the after-birth comes 
away, when it emerges from the vulva, it should be turned 
over and over several times for the purpose of forming 
a cord of the remaining shreds. Should the after-birth 
fail to be expelled, after trying the foregoing means, a 
competent physician should be called at once. 

When the after-birth is expelled the patient's limbs 
and the lower part of her trunk should be carefully 
sponged with warm water, and then thoroughly dried 
by means of a soft cloth, after which, all soiled articles 
must be removed from the bed; but do not allow the 
female to assume the erect posture for at least ten days. 

The gown should now be drawn down; an accurate 
fitting binder should be applied around the lower part 
of the body, to support the relaxed abdomen; and cloths 
should be loosely placed to the vulva, to receive the 
discharge and prevent its soiling the patient's garments 



484 THE PRACTICE OF MEDICINE. 

and bed-clothes. The new mother should now be properly 
covered and allowed to rest. 

When the child is properly washed, the dressing of 
the navel must next be attended to. A piece of soft linen, 
about four inches square, is taken, and a hole is cut in it 
large enough to admit the passage of the cord. The 
linen is then smeared with Vaseline or common lard and 
placed on the abdomen, with the cord passing through 
the hole. The stump of the cord is then made to point 
towards the child's left shoulder, and another piece of 
linen, greased as the first one, is laid over it. A bandage 
is then firmly applied around the body; but care must 
be used not to have it too tight. After the child is 
dressed it should be placed in the bed with its mother 
and allowed to nurse. This favors contraction of the 
womb, and is, therefore, beneficial to the mother, besides, 
the breasts contain a watery secretion that nature designed 
as the infant's first laxative. 

TREATMENT AFTER DELIVERY. 

Flooding: Lower the patient's head and shoulders; 
knead the abdomen over the region of the womb; and 
give a teaspoonful of the Fl. Ext. of Ergot every ten, 
twenty, or thirty minutes, owing to the severity of the 
hemorrhage. When the hemorrhage occurs before the 
delivery of the after-birth, in addition to the foregoing 
treatment, the after-birth must be removed at once. 

Admit a free current of fresh air into the patient's 
room; and if the pulse becomes weak administer stimu- 
lants, as Brandy, Whiskey, Aromatic Spirits of Ammonia, 



TREATMENT AFTER DELIVERY. 485 

the 1-40 to 1-30 of a grain of the Sulphate of Strychnine, 
etc. The latter may be used hypodermically. 

After- Pains: These may be relieved with 6 or 
8-grain . doses of Dover's Powder, or J-grain doses of the 
Sulphate of Morphine, every three or four hours as the 
urgency of the case demands. 

The Bowels : At the end of forty-eight hours after 
confinement, earlier than this if the patient has headache 
or fever, Salts or Oil should be given to procure an action 
from the bowels. After this the bowels should act each 
day. 

"Milk-Fever:" In the course of two or three days 
females usually have what is commonly called "milk- 
fever." This, as a rule, either precedes or accompanies 
the secretion of milk, and only lasts about twenty-four 
or thirty-six hours. Nothing is necessary in these cases 
except to control the fever and keep the bowels open with 
Oil, Salts or Seidlitz Powders. 

Fissured Nipples: Many nursing women suffer 
severely, after each confinement, with sore nipples. This 
may usually be prevented by washing the nipples four or 
five times a day with a solution of 20 grains of Tannin 
to the ounce of water for three or four weeks before the 
birth of the child. 

When the nipples are already fissured, or inflamed, 
a hot poultice should be applied to them and changed 
every hour until relief is obtained. The parts should 
then be washed with a solution of Carbolic Acid contain- 
ing 5 drops to the ounce of water; and the nipple should 



486 THE PRACTICE OF MEDICINE. 

be covered with lint, which must be kept wet with the 
same solution. If this treatment is followed, the soreness 
will rapidly disappear and the skin will heal in a few 
days. As long as the soreness remains, the nipple should 
be protected, when the child nurses, by a nipple-shield, 
which may be obtained at any first-class drug store. 
When once healed, the skin can be hardened, and a 
recurrence of the trouble prevented, by washing the 
nipple, each time, just after the child nurses, and then 
applying the solution of Tannin previously recommended. 

CARE OF THE INFANT. 

The child should be washed once a day with warm 
water and a good quality of toilet soap. After washing, 
those parts, which are liable to friction, as the arm-pits, 
buttocks, folds of the groins, etc., they should be well 
dried and then dusted with the following: 

Powdered Talcum, 4 drachms, 

Powdered Boracic Acid, 1 drachm, 

Powdered Oxide of Zinc, 3 drachms. 

Mix and use as a dusting powder. This course of 
cleanliness will usually prevent diseases of the skin. 

The dressing of the navel should not be disturbed 
until the stump of the cord separates from the body, 
which is usually from the fourth to the sixth day. A 
little Olive Oil may be applied to the dressing if it appears 
dry and hard. If the child fails to have an action from 
the bowels, in the course of ten or twelve hours 15 drops 
of Oil may be given. If there is scantiness of urine, or 
if the child fails to pass urine within a reasonable time 



CARE OF THE INFANT. 487 

after its birth, the urinary organs being perfect, 1 or 2 
drops of the Fl. Ext. of Buchu must be given every three 
or four hours until the desired effects are obtained. 

Inflammation of the Breasts: The newly born 
frequently have an inflammation of the breasts. The 
following is usually all that is required in these 
cases : 

Tr. of Camphor, 1 drachm, 

Olive Oil, 3 drachms. 

Mix and apply to the inflamed part every three hours. 
In addition to this, if the inflammation is severe, warm 
poultices should be used. 

Feeding the Infant: The only food that should be 
given to an infant before it is six months old is the milk 
of its mother. If, from any cause, it is impossible for 
the infant to obtain this, the best substitute is the fresh 
milk of a cow. When it is necessary to raise the child 
"by hand," or where the mother does not supply the 
requisite amount of nourishment, the milk, during the 
first month cf the child's life, should be allowed to stand 
an hour, when, the cream must be removed from its 
surface, and one part of water added to four parts of the 
milk, which should have a few grains of Sugar of Milk, 
or pure white sugar, and a trace of Salt added to it. 
After warming the milk, thus prepared until its temper- 
ature is tha: of the human body, it may be given to the 
child. 

After th.3 first month it is best to give the milk pure, 
or at most, with only a part of the cream removed. 



488 THE PRACTICE OF MEDICINE. 

MASTITIS. 

INFLAMMATION OF THE BREAST. 

Inflammation of the breast may occur at any time 
during lactation, but is more commonly met with soon 
after confinement. When the inflammation is not 
controlled during its first stage, it results in an abscess. 

It is due to the presence of a microorganism, but the 
predisposing causes are exposure to cold, bruises, and 
permitting the breast to become over distended with 
milk. Young mothers are more subject to it than others. 

Treatment: Confine the patient to bed and keep 
the breast empty. This may be accomplished by means 
of the breast-pump. Give the patient 2 drops of the 
Fl. Ext. of Phytolacca Decandra every three hours; and 
at the same time use the following: 

Tr. of Veratrum Viride (Norwood's), 1 ounce, 

Fl. Ext. of Phytolacca Decandra, 1 ounce, 

Glycerine, 1 ounce. 

Mix and apply to the breast every two or three hours. 
Keep the bowels open with Salts and if the patient has 
fever control it as you would in any other Idisease. 

Should this treatment fail to give relief liot poultices 
may be applied for the purpose of hastening the forma- 
tion of pus, which should be promptly emptied, when 
present, and the cavity cleansed with Peroxide d Hydrogen, 
and then dressed with Iodoform. 



PART X. 

MATERIA MEDICA. 

Materia Medica is that branch of medical science 
which treats of the remedies used in medicine. 

Medicines are divided into external and internal. 

External remedies may either be general, as the hot 
and the cold bath; or topical, when only applied to a 
particular part, as blisters, poultices, etc. 

Topical remedies have received names, which designate 
or point out, the particular effect produced, as: 

Rubefacients, or agents that cause a redness of the 
skin, as the various stimulating liniments, mustard- 
plasters, etc. 

Epispastics, or agents that cause blistering. 

Discutients, or agents that - tend to discuss or drive 
away swellings or risings. 

Refrigerants, or agents that allay heat. 

Escharotics, or articles that eat or corrode the tissues 
to which they are applied. 

Internal remedies have also been divided into classes, 
which have received names denoting the principal effect 
produced, or the particular organ on which they mostly 
act, as : 

480 



490 THE PRACTICE OF MEDICINE. 

Emetics, or agents that cause vomiting. 
Nauseants, or medicines that cause nausea, or a 
disposition to vomit. 

Cathartics, or agents that increase the number of 
evacuations from the bowels. When their action is mild 
they are called laxatives; when they cause three or four 
stools, ' they are called purgatives ; when their action is 
severe, and accompanied by pain and irritation, they 
are known as drastic cathartics; when they produce 
copious watery stools, they are called hydragogue cathartics ; 
and when they augment the flow of bile, they are termed 
cholagogue cathartics. 

Diuretics are medicines that increase the flow of 
urine. 

Emmenagogues are agents supposed to have the power 
of exciting, or promoting the menses. The greater 
number of this class are uterine tonics. 

Parturients are agents that promote labor, by arousing 
contractions of the womb. 

Abortives are agents that are capable of producing 
abortion. 

Diaphoretics are medicines that produce increased 
perspiration ; agents that cause copious perspiration are 
termed sudorifics. 

Expectorants are agents that facilitate the discharge 
of mucus and other substances from the air passages. 

Sialagogues are agents that increase the flow of saliva, 
or spittle. 



MATERIA MEDICA. 491 

Errhines, or sternutatories, are medicines, which, when 
snuffed up the nose, cause sneezing and a more or less 
copious discharge from the nose or nares. 

Antacids are agents that counteract or neutralize acidity. 

Antalkalines are agents that neutralize alkalinity. 

Disinfectants are agents that counteract offensive or 
unhealthy effluvia. 

Antiseptics are agents that resist putrescency, or a 
tendency to decomposition. 

Stimulants are medicines that have the power of 
exciting the organic action of the different systems of 
the economy. Some stimulants are diffusible, that is, 
have a prompt but temporary action; others are more 
permanent or persistent in their effect. 

Anthelmintics, or vermifuges, are agents that remove 
worms. 

Carminatives are agents that allay pain by causing 
the expulsion of gas from the alimentary canal. 

Tonics are agents that gradually give tone and vigor 
to debilitated organs or to the whole system. 

Antiperiodics are medicines that exert an influence 
antagonistic to that condition of the system which favors 
the presence of diseases of a periodic character, thereby 
curing them. 

Astringents are agents that cause contraction of the 
tissues with which they come in contact, thereby lessening 
or checking their discharges. When they exert their 
effect upon the .external surface of the body they are called 
Styptics. 



492 THE PRACTICE OF MEDICINE. 

Narcotics are agents that depress nervous action by 
their influence on the brain and spinal cord; they deaden 
sensibility, lessen the disposition to move, and produce 
sleep; in large doses they act as sedatives, frequently 
causing headache, giddiness, double vision, etc.; in small 
doses they generally act as stimulants. 

Anodynes are medicines that allay, or remove pain, 
by blunting the sensibility of the brain. 

Hypnotics are medicines that produce sleep. 

Sedatives are medicines that diminish the nervous, 
muscular and arterial forces; and are used when there 
is an exalted action of the functions of either or all of 
these systems. 

Antispasmodics are agents that have the power of 
allaying, or removing, spasms. They vary materially 
in their mode of action; some agents of this class acting 
as stimulants, others acting as sedatives or relaxants. 
Hence spasms due to debility require the former, while 
those due to mechanical irritation, call for the latter. 

Anaesthetics are agents that destroy sensation, as 
Chloroform and Ether. 

Alteratives are medicines that gradually restore health, 
by acting on the nutritive system, or by changing, or 
neutralizing, morbid or redundant matters in the circu- 
lation, and without any sensible increase of perspiration, 
or other excretions. 

Antaphrodisiacs are agents that lessen or blunt the 
sexual propensities. 



WEIGHTS AND MEASURES. 493 

Aphrodisiacs are agents that promote or excite the sex- 
ual propensities. 

Antipyretics arc agents that counteract fever. 

WEIGHTS AND MEASURES. 
apothecaries' weight. 

Apothecaries' Weight is used by druggists and physi- 
cians in weighing medicines for prescriptions. It is as 
follows : 

20 Grains (gr.) make 1 Scruple, marked, 3. 

3 Scruples " 1 Drachm, 5- 

8 Drachms " 1 Ounce, " g. 

12 Ounces " 1 Pound, " lb. 

In writing prescriptions, physicians express the number 

in Roman characters, using j instead of i final. They 

also write the symbol first; thus: 5 v., 5vj., 3ij. 

APOTHECARIES ' LIQUID MEASURE. 

Apothecaries' Liquid measure, is used in compounding 
and measuring liquid medicines. It is as follows: 
60 Drops (gtt.) or minims (m.) make 1 Drachm, /3- 
8 Drachms (Fluid) " 1 Ounce, /§. 

16 Ounces (Fluid) " 1 Pint, O. 

THE METRIC SYSTEM. 

The following contains all that is necessary to know 
to enable one to write prescriptions in the Metric System: 
.065 Gramm (Gm.) equals 1 Grain. 

1. Gramm " 15 J Grains. 

4. Gramms " equal 1 Drachm. 

30. Gramms " " 1 Ounce. 

.065 Cubic Centimeter (C.C.) equals 1 Gtt. or M. 



494 THE PRACTICE OF MEDICINE. 

i. Cubic Centimeter equals 15 J Gtt. or M. 
4. Cubic Centimeters equal 1 Drachm. 
30. Cubic Centimeters " 1 Ounce. 

In addition to these tables the following will be found 
useful : 

A teaspoonful is equal to 60 drops or 1 drachm. 
A tablespoonful is equal to 4 drachms, or \ ounce. 
A large wine-glassful is equal to 2 ounces. 
A tea-cupful is equal to 4 ounces. 

RELIABLE DRUGS. 

Ill purchasing drugs or having prescriptions rilled, 
see that you get a fresh article, manufactured by a repu- 
table firm, such as Parke, Davis and Company; The Wm. 
S. Merrell Chemical Company; or other reputable firms. 
It is dangerous and worse than useless to use inferior 
drugs. Insist on the best regardless of the price. 
VERATRUM VIRIDE. 

AMERICAN HELLEBORE. 

Veratrum is sedative, antipyretic and antispasmodic. 
It quiets the nervous system; weakens, or depresses, 
the heart's action; softens and slows the pulse and 
reduces fever. It has a tendency, even in small doses, 
to irritate the stomach, therefore, in all diseases of the 
stomach and bowels Aconite should be used in its stead. 
It is one of our most efficient remedies in all fevers where 
there is a full, strong, quick pulse. It is almost specific 
in puerperal convulsions. In these cases, it should be 
given in from 10 to 30-drop doses, preferably hypoderm- 
ically, every half-hour or hour, as the urgency of the case 



GELSEMIUM. 495 

demands, until relief is obtained or until the pulse is 
brought down to fifty per minute. In large doses it 
frequently acts as an emetic. When combined with equal 
parts of the Fl. Ext. of Phytolacca Decandra and 
Glycerine, and used locally, every three hours, it is very 
efficient in the first stages of inflammation of the breasts. 
Used locally twice a day it usually cures ringworm. 

Norwood's Tincture, which is equal in strength to a 
good Fluid Extract is its most reliable preparation. The 
dose is from 1 to 3 drops every one or two hours. 

ACONITUM NAPELLUS. 

ACONITE. 

Aconite is sedative, antipyretic, diaphoretic and diuretic. 
It may be used in all fevers, inflammations or other 
diseases where the pulse is too quick and too full. It 
reduces fever, slows and softens the pulse, by depressing 
the heart's action, and, is quieting to an irritated stomach. 
In diseases of the stomach and bowels, attended by fever, 
it should be used instead of Veratrum. It is especially 
the remedy in fevers or inflammations of children. The 
Tr. of Aconite Root is the form that should be used. 

The dose of the Tr. is from 1 to 5 drops every one or 
two hours. 

GELSEMIUM. 

YELLOW JASMINE. 

Gelsemium is sedative, antipyretic, antispasmodic, and 
diaphoretic. It reduces fever, slows and softens the 
pulse. Combined with Veratrum or Aconite it is our 
very best remedy in active congestion and inflammation 



496 THE PRACTICE OF MEDICINE. 

of the brain. It should be given in all fevers and inflam- 
ations where there is flushed face with bright eyes and 
contracted pupils. In from 5 to 10-drop doses combined 
with from 3 to 5 grains of Acetanilide it is almost specific 
for headache, especially that of a throbbing character. 
It is one of our most efficient remedies in convulsions 
arising from active congestion or inflammation of the 
brain. In these cases, the first dose should not be less 
than 10 drops, administered, preferably, hypodermically, 
after which it may be repeated in smaller doses every 
hour as the urgency of the case demands. Combined 
with Veratrum, or alone, it is efficient in puerperal convul- 
sions. It is a very valuable remedy in facial neuralgia. 
In these cases, it must be given every hour commencing 
with 5 drops and increasing the dose one drop each hour 
until it relieves the pain or produces double vision, 
dizziness, drooping of the upper eyelids or dropping of the 
under jaw. It is also a valuable remedy in dysmenorrhcea, 
ovarian neuralgia, orchitis, renal colic, etc. The Fluid 
Extract is the form that should be used. 

The dose of the Fl. Ext. of Gelsemium is from 1 to 
10 drops every one or two hours. 

POTASSII BROMIDUM. 

BROMIDE OF POTASH. 

Bromide of Potash is sedative, antispasmodic, and 
slightly hypnotic. It depresses the heart and has some 
tendency to reduce fever. It may be used in active 
congestion or inflammation of the brain and convul- 
sions, where Gelsemium is recommended, however, it 



DIGITALIS. 497 

is inferior, in these cases, to this remedy. It is given in 
large doses, with benefit, in epilepsy. It has a tendency to 
irritate the stomach; and decreases the sexual propensity. 
The dose is 5 to 20 grains every one or two hours. 
In epilepsy 20 to 60 grains three times a day. 

As all the Bromides have practically the same effect 
we .will append a list containing the leading ones of this 
class, giving their doses: 

Bromide of Sodium, dose, 5 to 60 grains. 

Bromide of Lithium, dose, 5 to 20 grains. 

Bromide of Ammonium, dose, 5 to 20 grains. 

Bromide of Calcium, dose, 5 to 60 grains. 

Bromide of Zinc, dose, J to 2 grains. 

ACETANILIDE. 

Acetanilide is antipyretic, anodyne, antispasmodic and 

in large doses sudorific. It is a heart-depressant and 

may be given with perfect safety and great benefit in all 

fevers and inflammations where the skin is dry and the 

pulse too full and too quick. It should not, under any 

circumstance, be given, where the patient has passive 

congestion of the brain. Combined with from 5 to 10 

drops of the Fl. Ext. of Gelsemium it is almost a specific 

for headache, especially where the pain is of a throbbing 

character. 

The dose is from 3 to 5 grains every three or four hours. 
DIGITALIS. 

FOX-GLOVE. 

Digitalis is a heart-stimulant and tonic, diaphoretic 
and diuretic. It reduces fever but strengthens the pulse. 



498 THE PRACTICE OF MEDICINE. 

It should be given in all fevers or other conditions where 
the pulse is weak or irregular. It strengthens the pulse 
but reduces its frequency, therefore, it is contra- indicated 
where the pulse is abnormally slow. The combination 
of Digitalis and Cactus makes one of our most efficient 
heart-stimulants and tonics. 

The dose of the Fl. Ext. of Digitalis is i drop every 
two hours. When used in chronic heart-diseases it 
may be given in doses of from i to 3 drops three or four 
times a day. 

CACTUS GRANDIFLORUS. 

NIGHT-BLOOMING CEREUS. 

Cactus is a heart-tonic and stimulant, and may be 
used in all fevers, inflammations, or other diseases where 
the pulse is weak or irregular. It may be given where the 
pulse is abnormally slow. Combined with Digitalis it 
makes one of our most efficient heart-stimulants and 
tonics. The Fl. Ext. is the form used. 

The dose is two drops every two hours. When used 
for chronic heart-disease the dose may be from 2 to 5 
drops three or four times a day. 

BELLADONNA. 

DEADLY NIGHT-SHADE. 

Belladonna is narcotic, antispasmodic and anodyne. In 
small doses it stimulates the heart and is our very best 
capillary stimulant. It should be given in all fevers and 
inflammations where the patient is drowsy, jumping, 
jerking, or becoming frightened while asleep, the pupils 
being too large and not contracting upon exposure to a 



STRYCHNIA. 499 

bright light, indicating passive congestion of the brain. 
It is efficient in controlling profuse perspiration during 
or following exhausting diseases. Combined with Ergot 
and Rhus Aromatica it usually relieves nocturnal incon- 
tinence of urine- in children. 

The Sulphate of Atropine, the active principle of 
Belladonna, 1-60 of a grain combined with the 1-20 of a 
grain of the Sulphate of Strychnine and given at one 
dose, hypodermically, is the very best treatment for the 
cold stage of congestive intermittents. Atropine is also 
efficient in night-sweats. 

The dose of the Sulphate of Atropine is from 1-100 to 
1-60 of a grain. 

The dose of the Fl. Ext. of Belladonna is from 1-3 to 3 
drops every one or two hours. 

STRYCHNIA. 

Strychnine is a heart stimulant and nerve-tonic. It 
is made from Nux Vomica but is far inferior to this article 
as a general and stomachic tonic. When Strychnine 
is used in the form of the Sulphate or Nitrate it is one of 
our most powerful heart-stimulants and tonics. It may 
be given in all diseases where the pulse is weak, especially 
where the patient is prostrated. In large doses it is our 
most efficient remedy in the stage of collapse in cholera, 
cholera morbus or other exhausting diseases. 

It is a valuable remedy in paralysis. Theoretically, 
the Elixir of Phosphate of Iron, Quinine and Strychnine 
is a very valuable tonic, but practically it is almost worth- 



500 THE PRACTICE OF MEDICINE. 

less. Its dose is from i to 2 drachms three times a day. 
Strychnine may be used hypodermically. 

The dose of the Sulphate or the Nitrate of Strychnine 
is from 1-64 to 1-12 of a grain every four hours. Of course, 
the latter dose should only be given in extreme cases. 
The average dose is about 1-40 of a grain every three or 
four hours. 

NITROGLYCERINE. 

GLONOIN. 

Nitroglycerine in doses of from 1-150 to 1-100 of a grain 
is a heart-stimulant and may be given in angina pectoris 
and when the heart' s action is extremely weak, in 
pneumonia. It may be given hypodermically. Tablets 
containing the required dose may be obtained at any first- 
class drug store. The dose, as previously stated, is from 
1-150 to 1-100 of a grain, however, the large dose should 
not be used except in extreme cases. 

NITRITE OF AMYL. 

The Amyl Nitrite, is a heart-stimulant and anti- 
spasmodic. It is useful in counteracting the effects of 
Chloroform, and in angina pectoris and epilepsy. Perles 
containing the proper dose may be obtained. It is usually 
used by inhalation, in epilepsy, when the attack is felt 
coming on. The dose is from 3 to 5 drops. 

SULPHATE OF SPARTEINE. 

The Sulphate of Sparteine . is a heart-stimulant and 
may be used in all conditions where the pulse is weak or 
irregular, especially in chronic diseases of the heart. 






CAMPHOR. 501 

The dose is J of a grain, however, this may be cau- 
tiously increased to 1 grain. It may be given every four 
hours. Tablets containing the required amount may be 
obtained at any first-class drug store. 

CITRATE OF CAFFEINE. 

Caffeine is a heart-stimulant and is made from coffee, 
and is identical with Them, which is obtained from tea. 
It may be used in all conditions where Digitalis is recom- 
mended, but is far inferior to this drug. 

The dose is from 2 to 5 grains every three or four 
hours. 

AROMATIC SPIRITS OF AMMONIA. 

The Aromatic Spirits of Ammonia is a heart-stimulant 
and also a diffusible stimulant. It may be used in all 
conditions where a stimulant is indicated, such as syncope, 
collapse, or other forms of sudden heart-failure. It is 
an efficient antacid in heart-burn dependent upon acidity 
of the contents of the stomach. 

The dose is from 20 to 60 drops, largely diluted with 
water, every half-hour, hour, two or three hours as the 
urgency of the case demands. 

CAMPHOR. 

Camphor is a heart-stimulant, antispasmodic, carmin- 
ative and rubefacient. As a stimulant it may be used in 
the cold stage of intermittents and in low forms of fevers. 
As an antispasmodic it may be used in hysteria, hiccough, 
dysmenorrhoea, whooping-cough, chordee, etc. As a car- 
minative it may be used in colic and irritable diarrhoeas. 
As a rubefacient, it is much used in the form of a liniment, 



502 THE PRACTICE OF MEDICINE. 

in sprains, bruises, rheumatism, etc. It lessens the sexual 
propensities. Poisonous doses produce headache, vertigo, 
ringing in the ears, a rapid feeble pulse, convulsions and 
collapse. 

The dose of the Gum is from i to 5 grains ; the Spirits, 
from 10 to 30 drops every four hours. 

CAPSICUM. 

CAYENNE PEPPER. 

Capsicum is a stimulant and stomachic tonic; and, 
when applied externally, is a rubefacient. Large doses 
produce severe irritation of the stomach and bowels and 
also of the kidneys. In the form of a liniment it is some- 
times efficient in wryneck, rheumatism, sprains, etc. 
Following an alcoholic debauch, and in the dyspepsia of 
the aged it is a valuable stomachic. It may be employed 
to promote the absorption of Quinine. Applied externally 
in the form of a plaster it is an efficient counter-irritant. 

Dose of the powder 1 to 3 grains; of the Fl. Ext. 1 to 
3 drops, and of the Tr. 8 to 15 drops, three or more times 
a day. 

WHISKEY. 

Whiskey, in small doses, is a stimulant, and in large 
doses is a narcotic. It is a valuable remedy in the latter 
stages of pneumonia and in all low forms of fever. When 
combined with fresh, sweet milk, or, in the form of egg- 
nog, it is also a valuable food. It may be used in all 
conditions demanding a stimulant. It is a valuable remedy 
in the treatment of poisonous bites and stings, however, 
it should not be given in sufficient amounts to produce 



QUINIDINA (ALKALOID). 503 

drunkenness. Owing to the depressing effect of the virus 
it requires more of it to produce intoxication than under 
ordinary circumstances. The intoxicating properties in 
Whiskey, Wine, Brandy, Beer, etc., is Alcohol, therefore, 
when Whiskey cannot be obtained Alcohol may be diluted 
and used in its stead. 

The proper amount of Whiskey to be used during 
twenty-four hours is from 4 to 10 ounces. 

QUININIA. 

QUININE. 

Quinine is our very best antiperiodic. It is also a 
valuable tonic. If rightly used, even chronic malaria 
could almost invariably be cured by it alone. It is the 
remedy for any ache, pain or fever, that comes on at a 
certain time each day. The proper way to use it, is to 
-commence six and one-half hours before the expected 
appearance of the ache, pain, chill, or fever and give 5 
grains of the Sulphate of Quinine every two hours until 
four doses are taken. When taken in this manner the 
last dose is taken half an hour before the expected 
paroxysm. In congestive chills the dose should be 10 
grains; and the patient must be kept under the influence 
of the drug until all danger of another paroxysm is passed. 
In remittent fever give it during the remission. 

Combined with Dover's Powder it is efficient in colds. 
QUINIDINA (ALKALOID). 

QUINIDINE. 

Quinidine is the alkaloid of Peruvian Bark and may be 
used in all cases where the Sulphate of Quinine is used 
and in the same size dose. 



504 THE PRACTICE OF MEDICINE. 

Potter claims that it is more efficient as an antiperiodic 
than the Sulphate of Quinine. When combined with 
Simple Syrup, as follows, it makes the " Tasteless Syrup 
of Quinine:" 

Quinidine (alkaloid), 80 grains, 

Simple Syrup, sufficient to make, 2 ounces. 

Mix. Each teaspoonful contains 5 grains of the 
Quinidine, the proper dose for an adult. 

ARSENICUM. 

ARSENIC. 

Arsenic, in small doses, is an efficient general and 
stomachic tonic and is one of our most efficient remedies 
in the treatment of chronic malaria. It may be given in 
any condition where patients need building up. It has 
given good results, in doses of 2 or 3 drops, of Fowler's 
Solution, every five hours, in ulcer of the stomach. It 
is usually efficient in the treatment of chorea, however, 
in these cases, large doses are required. The following 
is said to be efficient in removing cancers and cancerous 
growths : 

Arsenious Acid, 2 drachms, 

Powdered Gum Arabic, 1 drachm, 

Hydrochlorate of Cocaine, .18 grains. 

Mix and add a sufficient amount of water to form a 
paste of the consistency of thick cream. This should 
be spread on rubber-plaster and applied to the sore or 
tumor and allowed to remain from eighteen to thirty-six 
hours, when, if required, a fresh application may be made. 
These plasters cause the tumor or growth to turn black, 



HYDRASTIS CANADENSIS. 505 

their edges being surrounded by an inflamed border. 
After removing the plaster a flax-seed-meal poultice should 
be applied and continued until the slough separates, when, 
the sore may be treated as an ordinary ulcer. 

Fowler's Solution of Arsenic (Liquor Potassii 
Arsenitis) is the form of it usually used internally. 

The dose is from 1 to 10 drops three times a day. 
The dose of Arsenious Acid is from 1-40 to 1-10 of a 
grain. 

NUX VOMICA. 

Nux Vomica is a general tonic and may be used in all 
conditions, in the absence of fever, where patients are 
weak or debilitated from any cause. It increases the 
appetite, improves digestion, stimulates the heart, and 
is our very best nerve-tonic. When combined with 
Quinine, Hydrastis and Arsenic it makes the best treat- 
ment known for chronic malaria. It is efficient in 
dyspepsia; and combined with other remedies makes our 
most efficient " female tonic." 

The dose of the Fl. Ext. of Nux Vomica is from 3 to 
5 drops before each regular meal. - ■ 

HYDRASTIS CANADENSIS. 

GOLDEN SEAL. 

Hydrastis is tonic, antiperiodic and antiseptic. It 
stimulates the liver and the secretions of the stomach 
and bowels. In the treatment of malaria it stands next 
to Quinine. As a stomachic tonic it has no superior and 
when combined with other remedies, as Nux Vomica 
and Gentian, it is almost specific in atonic dyspepsia. 



506 THE PRACTICE OF MEDICINE. 

It makes an excellent mouth-wash, eye-water, and wash 
in gonorrhoea, leucorrhcea and old sores. 

The dose of the Fi. Ext. of Hydrastis is from 10 to 
30 drops three times a day before meals. 
GENTIANA LUTEA. 

GENTIAN. 

Gentian is one of our most reliable stomachic tonics. 
It is a very valuable remedy in chronic indigestion, in the 
dyspepsia of consumption and in the early stages of cancer 
of the stomach. It may be given, advantageously, in all 
conditions where patients are debilitated. 

The dose of the Fl. Ext. of Gentian is from 30 to 60 
drops three times a day before meals. 
OLEUM MORRHlL£. 

COD-LIVER OIL. 

Cod-Liver Oil is a food rather than a medicine, and, 
as such, it is undoubtedly inferior to good fresh cream, 
butter or other palatable and nutritious articles; but 
should the reader be determined to use it, the dose is from 
1 to 4 drachms floated on the surface of Whiskey or in 
capsules two or three hours after meals. It is usually 
given in pulmonary tuberculosis and other conditions 
where there is persistent loss of flesh. 

PHOSPHORUS. 

Phosphorus is a nerve-tonic, and in small doses stimu- 
lates the growth of bones. It "may be used in chronic 
nervous exhaustion, neuralgia, anaemia, wakefulness of 
the aged, locomotor ataxia, threatened softening of the 
brain; and is a valuable remedy in impotence, especially 



TR. FERRI CHLORIDI. 507 

that of a functional character. It may be used in the 
form of the Phosphide of Zinc, in doses of 1-30 to 1-10 
of a grain, or Phosphorus, in pill-form in doses of 1-100 
to 1-50 of a grain three times a day after meals. 

TR. FERRI CHLORIDI. 

TR. MURIATE OF IRON. 

Theoretically Iron is a very valuable tonic in all anaemic 
conditions, but practically it is not, probably, so good. 
It may be used in all conditions where the lips and tongue 
show a want of color, such as is seen in chlorosis, however, 
in these cases, the Dialyzed Iron should be given in doses 
of from 10 to 30 drops. The Tr. of Muriate of Iron is 
a valuable remedy in erysipelas. In these cases, it may 
be given in from 10 to 30-drop doses, largely diluted with 
water, every three or four hours. Combined with Chlorate 
of Potash, Water, and Glycerine it makes a valuable 
gargle in throat troubles, especially, tonsillitis. 

Monsel's Solution (Liquor Ferri Subsuiphatis) is our 
most efficient styptic and may be used locally, undiluted 
in all hemorrhages; and in hemorrhage from the stomach 
it may be given in doses of 5 drops well diluted. The 
Hydrated Oxide of Iron is the antidote to poisoning by 
Arsenic. The dose, in these cases, is a tablespoonful or 
more every few minutes. 

The dose of the Tr, of the Chloride of Iron is 
from 5 to 30 drops, well diluted; in acute diseases, every 
three or four hours; in chronic diseases three times a 
day. 



508 THE PRACTICE OF MEDICINE. 

DAMIANA. 

Damiana is tonic and in large doses a laxative. It is 
a useful remedy in impotence, increasing the sexual desire 
and the power of the reproductive organs. It is also 
efficient in renal and cystic catarrh and in irritation of 
the urinary passages. It is also valuable in respiratory 
disorders, especially those accompanied by profuse secretion. 

The dose of the Fl. Ext. of Damiana is from 30 to 60 
drops three or four times a day. 

COLINSONIA CANADENSIS. 

STONE-ROOT. 

Colinsonia is a stomachic tonic, also a heart- tonic. 
It is a useful remedy in chronic laryngitis; and, combined 
with Hydrastis it is a very efficient remedy in chronic 
gastric catarrh. It is also an efficient remedy in hem- 
orrhoids, especially where there is a relaxed condition 
of the lower bowel, with a sense of fullness, or of a foreign 
body in the rectum. Where the heart's action is feeble, 
combined with Cactus, it produces good results. 

The dose of the Fl. Ext. of Colinsonia Canadensis 
is from 5 to 15 drops three or four times a day. 
CRATAEGUS OXYCANTHA. 

HAWTHORNE. 

Crataegus Oxycantha is an efficient remedy in angina 
pectoris, hypertrophy of the heart, valvular insufficiency 
and precordial oppression. In cardiac dropsy its action 
is very beneficial, and, in other forms of dropsy it is said 
to produce good results. It is said to cure diseases of 
the heart where all other remedies have failed. 



HYDRARGYRUM. 509 

The dose of the Fl. Ext. of Crataegus Oxycantha is 
from 10 to 15 drops three or four times a day. 
HUMULUS LUPULUS. 

HOPS. 

Humulus Lupulus is a tonic and hypnotic. It aids 
digestion and adds force and volume to the heart; and, 
when this organ is irregular from indigestion, by stimu- 
lating the stomach, it often relieves. It is quieting to the 
nervous system and is useful in insomnia, facial neuralgia, 
delirium tremens and is an efficient remedy in priapism 
and chordee. It is an aphrodisiac. 

The dose of Lupulin, which is made from Hops and 
has the same effects, is from 5 to 15 grains. 

The Fl. Ext. of Humulus Lupulus is from 10 to 30 
drops, repeated as is required. 

CHIONANTHUS VIRGINICA. 

FRINGE TREE. 

Chionanthus is tonic, and a very efficient cholagogue. 
It should be given in all diseases where there is yellowness 
of the eyes or skin indicating biliousness. When combined 
with the Fl. Ext. of Nux Vomica, it is the most efficient 
remedy, in jaundice, known to this writer. 

The dose of the Fl. Ext. of Chionanthus Virginica 
is from 10 to 30 drops, three or four times a day. 
HYDRARGYRUM. 

MERCURY ; QUICKSILVER . 

We shall confine our remarks to the four most impor- 
tant forms of Mercury; Calomel, Bichloride, Biniodide, 
and Turpeth Mineral. 



510 THE PRACTICE OF MEDICINE. 

HYDRARGYRI CHLORIDUM MITE. 

CALOMEL. 

Calomel is sialagogue, cathartic, diuretic and probably 
a stimulant to the lympathic system. It is now very 
generally admitted to be a sedative to the liver instead 
of a stimulant. It has been more used and abused than 
any other remedy in the whole Materia Medica, however, 
when properly used it is perfectly harmless and a very 
valuable remedy. It should be given in all fevers and 
inflammations where there is a yellowish coating on the 
tongue, especially if this organ is rather dry. It should 
always be combined with Ipecac and Soda, when given, 
thus: 

Calomel, i grain, 

Powd. Ipecac, i grain, 

Bicarbonate of Soda, ■ . 10 grains. 

Mix and divide into five powders and give one every hour. 
These usually act very nicely on the bowels, but should 
they fail, Oil, Salts or a Seidlitz Powder must be given. 

Never, under any circumstances, should more than 
one grain of Calomel be introduced into the system at 
one time, however, this amount may be given and repeated 
from day to day as is indicated throughout the attack of 
sickness. When used in small doses we obtain all of its 
beneficial effects and none of its injurious effects. 

The writer is thoroughly convinced that many cases 
of intractable diarrhoea, hemorrhage, and even perfora- 
tion of the intestines, in typhoid fever, occur as a result 
of large doses of Calomel, or other cathartics, administered 



HYDRARGYRI CHLORIDUM CORROSIVUM. 511 

at the beginning of the attack. Where the excessive use 
of cathartic medicines does not produce these results, 
there is no doubt whatever, in the writer's mind, but 
what they so weaken patients with typhoid fever, pneu- 
monia, and other exhausting diseases, that many of them 
finally die of weakness, when, had it not been for the 
excessive use of cathartics they may have recovered. 
Remember that cathartics cure no known disease. All 
up-to-date physicians have long since abandoned the use 
of harsh cathartics in the treatment of fevers and inflam- 
mations. 

Calomel in 1-5 -grain doses every hour until five are 
taken is efficient in quieting an irritable stomach, espe- 
cially when the bowels are constipated. 

The dose of Calomel is 1-10 to 1-5 of a grain every 
half-hour or hour until one grain is taken. Tablets of it 
the required size may be obtained at any first-class drug 
store. 

HYDRARGYRI CHLORIDUM CORROSIVUM. 

CORROSIVE SUBLIMATE; BICHLORIDE OF MERCURY. 

Corrosive Sublimate is alterative, antiseptic and 
parasiticide. As an alterative it is one of our most 
efficient remedies, especially, when combined with Iodide 
of Potash as in the following: 

Corrosive Sublimate, 2 grains, 

Iodide of Potash, 1 ounce, 

Water, sufficient to make, 6 ounces. 

Mix; the dose is a teaspoonful after each regular meal. 
It is especially efficient in constitutional syphilis, usually 



512 THE PRACTICE OF MEDICINE. 

being all that is required in these cases. It may also be 
used in all diseases where an alterative is indicated. Its 
use as an internal antiseptic is of doubtful utility. 

As an antiseptic or germicide, when used externally, 
it is one of our most efficient agents. It unites with 
albuminous matter forming an inert compound, therefore, 
to prevent this, a small amount of Citric Acid should 
be added to it, thus: 

Corrosive Sublimate, 7 J grains, 

Citric Acid, 4 grains, 

Water, 1 • pint. 

Mix; this makes a 1 to 1000 solution, and if half the 
amount of water is used the strength, of course, would be 
1 to 500; and if one quart of water is used the strength of 
the solution would be 1 to 2,000. Using these statements, 
by a simple calculation, the reader may make a solution 
of any strength desired. If the water with which the 
solution is made contains lime a small amount of common 
salt should be added to it; this prevents the formation of 
a precipitate. 

For rendering the skin and hands aseptic after washing 
thoroughly with warm water and soap, a solution of from 
1 to 500 or 1 to 1,000 should be used. On small wounds 
a solution of from 1 to 2,000 to 1 to 1,000 may be used, 
but on large wounds or in large cavities a solution of 1 
to 10,000 or 1 to 5,000 should be used. Corrosive 
Sublimate is very poisonous, therefore, when it is used on 
a large wound or in a large cavity the solution should not 
be strong. It should not be used in the peritoneal cavity. 






HYDRARGYRI IODIDUM RUBRUM. 513 

It makes an efficient wash in cystitis, leucorrhcea and 
gonorrhoea. In these cases, the strength of the solution 
may be from 1 to 10,000 to 1 to 5,000. 

It is an efficient parasiticide in pediculosis pubis and 
ringworm. In these cases, the solution should be rather 
strong and applied every two or three days until a cure 
is effected. 

Bichloride is capable of destroying most bacteria even 
in solutions of 1 to 20,000 and their spores, in solutions 
of 1 to 10,000. Some microorganisms, as the bacillus 
of anthrax, are much less susceptible to its influence than 
other forms. 

The dose of Corrosive Sublimate is from 1-64 to 1-10 
of a grain, three times a day after meals. We do not 
recommend the dose as large as 1-10 of a grain, neither 
do we recommend its use internally as an antiseptic 
believing that we possess more efficient internal anti- 
septics. 

HYDRARGYRI IODIDUM RUBRUM. 

BINIODIDE OF MERCURY. 

Biniodide of Mercury is similar in its effects to the 
Bichloride but we only wish to use it as an alterative, 
and especially in constitutional syphilis. It may be pre- 
pared for use as follows: 

Biniodide of Mercury, 3 grains, 

Alcohol, 1 ounce. 

Mix and give ten drops three times a day after 
meals, or: 



514 THE PRACTICE OF MEDICINE. 

Biniodide of Mercury, 3 grains, 

Iodide of Potash, 1 ounce, 

Water, sufficient to make, 6 ounces. 

Mix and give a teaspoonful after each regular 
meal, or: 

Biniodide of Mercury, 3 grains, 

Iodide of Potash, 1 ounce, 

Compound Syr. of Stillingia, sufficient to make, 6 ounces. 
Mix and give a teaspoonful after each regular meal. 
Either of these prescriptions is very efficient in 
secondary or tertiary syphilis. 

The dose of Biniodide of Mercury is from 1-50 to 1-12 
of a grain three times a day after meals. 

HYDRARGYRI SUBSULPHAS FLAVUS. 

TURPETH MINERAL. 

This preparation of mercury is an emetic and was 
formerly much used in croup but it has been replaced to 
a great extent, by less poisonous and less irritating drugs. 

The dose is from 2 to 3 grains repeated only once. 
COMPOUND SYRUP OF STILLINGIA. 

The Compound Syrup of Stillingia is an alterative 
and may be used in all conditions where such agents are 
indicated but its principal use is as a menstruum for more 
potent remedies. 

The dose is from 1 to 2 drachms three times a day. 
POTASSII IODIDUM. 

IODIDE OF POTASH. 

The Iodide of Potash is one of our most efficient 
alteratives and is a valuable remedy in a variety of morbid 



CALX SULPHURATA. 515 

conditions. It is efficient in constitutional syphilis; lessens 
the pain of aneurism; and is believed by many physicians, 
to be curative in these cases. It is efficient in pleurisy 
after the stage of effusion; chronic rheumatism; boils; 
asthma; and lead-poisoning. 

Large doses of the drug cause burning in the stomach, 
nausea, vomiting and diarrhoea. The continuous use 
of it frequently causes headache; lachrymation ; running 
from the nose; sneezing; soreness of the throat; an 
increased flow of saliva; and an eruption on the skin. 
When these symptoms occur the dose should be decreased 
or the drug discontinued for a few days. Some patients 
do not bear it well, especially those suffering with chronic 
Bright 's disease. As much as 300 grains, or more, of 
the drug have been given daily, but there does not seem 
to be any good reason or common sense in giving such 
enormous amounts. 

The dose of Iodide of Potash is from 5 to 20 grains 
three times a day after meals. 

CALX SULPHURATA. 

SULPHIDE OF CALCIUM. 

Sulphide of Calcium is an alterative and is efficient in 
arresting suppuration. It has been found especially useful 
in pustular acne, boils and carbuncles. It is an efficient 
remedy in follicular tonsillitis and good results have 
followed its use in diphtheria. 

The dose of the Sulphide of Calcium is from § to 2 
grains every one, two, or three hours. 



516 THE PRACTICE OF MEDICINE. 

IODUM. 

IODINE. 

Iodine is an alterative disinfectant and deodorant, and 
when applied to the skin is irritant. It was formerly 
much used as a local application in erysipelas but is now 
replaced by more efficient and less disagreeable remedies. 
It is efficient when used in the form of the Tincture in 
the treatment of ringworm. 

Combined with Carbolic Acid, as in the following 
formula, it is very efficient in the treatment of typhoid 
fever, especially when the tongue is red and dry. 

Tr. of Iodine, i drachm, 

Carbolic Acid, i drachm, 

Powd. Gum Arabic, i drachm, 

Water, sufficient to make, 4 ounces. 

Mix and give a teaspoonful every four or six hours. 
In preparing the above prescription first dissolve the Gum 
Arabic in water, then, add the other articles. 

The dose of the Tr. of Iodine is from 1 to 5 drops 
three or more times a day. 

PHYTOLACCA DECANDRA, 

POKE-ROOT. 

Poke-root is an alterative, in large or poisonous doses, 
it is emetic, cathartic, and narcotic. 

It is a very efficient remedy in the treatment of 
inflammation of the glandular structures, especially of 
the lymphatic glands. Administered internally, and at 
the same time applied externally by means of absorbent 
cotton saturated with the Fluid Extract it is efficient in 



CIMICIFUGA RACEMOSA. 517 

aborting buboes and inflammation of other glands, as the 
sublingual, submaxillary, etc. It is also very efficient 
in inflammation of the breasts of nursing women. It 
is also one of our most useful remedies in the treatment 
of orchitis, ovaritis, prostatitis, laryngitis, pharyngitis, 
tonsillitis and even diphtheria. Combined with Salicylate 
of Soda, made from Wintergreen, and Cimicifuga it is 
the very best treatment for rheumatism. 

The dose of the Fl. Ext. of Phytolacca Decandra is 
from 1 to 10 drops every two or three hours to three or 
four times a day. 

AURI ET SODII CHLORIDUM. 

CHLORIDE OF GOLD AND SODA. 

The Chloride of Gold and Soda, is alterative and tonic 
and often remarkably retards the progress of locomotor 
ataxia. It is also a useful remedy in syphilis, amenor- 
rhcea, and functional impotence, etc. 

The dose is from 1-30 to 1-16 of a grain, in pills, 
three times a day. 

CIMICIFUGA RACEMOSA. 

BLACK COHOSH. 

Cimicifuga is anti-spasmodic, aphrodisiac, diaphoretic, 
diuretic, and expectorant. It is a useful remedy in 
wryneck, muscular soreness and rheumatism. It is one 
of our best remedies in chorea. In these cases it should 
be used in large doses. It stimulates the sexual organs 
and is a very efficient female-tonic. 

The dose of the Fl. Ext. of Cimicifuga is from 5 to 30 
drops every two hours to three or four times a day. 



518 THE PRACTICE OF MEDICINE. 

CAULOPHYLLUM THALICTROIDES. 

BLUE COHOSH. 

Blue Cohosh is emmenagogue, anti-spasmodic and 
slightly diuretic. It is an efficient remedy in dysmen- 
orrhcea and pain in the region of the uterus. 

The dose of the Fl. Ext. of Caulophyllum is from 10 
to 30 drops three times a day. 

THUJA OCCIDENTALS. 

ARBOR VIT^:. 

Thuja is emmenagogue, and is said to be efficient. 

The dose of the Oil of Thuja is from 1 to 5 drops three 
times a day. The Tr. of it may be applied to warts two 
or three times a day. 

VIBURNUM PRUNIFOLIUM. 

BLACK HAW. 

Black Haw is a sedative and tonic to the uterine and 
ovarian nerve-centers. It is a very efficient anti-abortive 
and is also useful in uterine congestion, ovarian irritation, 
irregular menstruation, dysmenorrhcea, and menorrhagia. 

The dose of the Fl. Ext. of Viburnum is from 20 to 
60 drops, three or four times a day. 

PULSATILLA. 

PASQUE-FLOWER. 

Pulsatilla is a stimulant to that portion of the sym- 
pathetic nervous system influencing the reproductive or- 
gans. It is especially useful in uterine disorders and dis- 
eases of the sexual organs in both males and females, at- 
tended "by fear of impending danger. 



ERGOTA. 519 

The dose of the Fl. Ext. is from 3 to 5 drops three or 
four times a day. 

HEDEOMA PULEGIOIDES. 

PENNYROYAL. 

Pennyroyal is an emmenagogue especially in suppres- 
sion of the menses brought on by exposure. It should 
be given during the time the menstrual flow should occur 
and the patient should take a hot sitz-bath each night. 

The dose of the Infusion of Pennyroyal is from 1 to 
2 ounces. 

The dose of the Oil of Pennyroyal is from 3 to 10 
drops three times a day. 

GOSSYPII RADICIS. 

COTTON-ROOT BARK. 

Gossypium is an emmenagogue and is sometimes an 
efficient remedy in amenorrhea. 

The dose of the Fl. Ext. of Gossypium is from 30 to 
45 drops three times a day. 

CINNAMOMUM. 

CINNAMON. 

Cinnamon is efficient in checking menorrhagia and 
may be combined with Ergot in these cases. 

The dose of the Oil of Cinnamon is from 1 to 5 drops. 

The dose of the Spirits of Cinnamon is from 10 to 30 
drops every one or two hours. 

ERGOTA. 

ERGOT. 

Ergot is a hemostatic and parturient. In large doses 
it acts as a gastro-intestinal irritant, causing nausea, 



520 THE PRACTICE OF MEDICINE. 

vomiting, purging, colic, difficult micturition, and thirst. 
The continued use of it either produces convulsions or 
gangrene. 

It is our most efficient remedy in controlling internal 
hemorrhages. In hemorrhage from the lungs, stomach, 
and kidneys, it should be given combined with Rhus 
Aromatica, thus: . 

Fl. Ext. of Ergot, i ounce, 

Fl. Ext. of Rhus Aromatica, i ounce. 

Mix and give from a half to a teaspoonful every hour 
or so until relieved. In uterine hemorrhage it may be 
given in teaspoonful doses every half-hour or hour as 
the urgency of the case demands. In menorrhagia it 
may be combined with cinnamon, as follows: 

Spirits of Cinnamon, i\ ounces, 

Fl. Ext. of Ergot, 2\ ounces. 

Mix and give a teaspoonful every one, two, or three 
hours as the urgency of the case demands. 

It is also efficient in enuresis and nocturnal inconti- 
nence of urine, especially when combined with the fol- 
lowing : 

Fl. Ext. of Belladonna, i drachm, 

Fl. Ext. of Rhus Aromatica, 2 ounces, 

Fl. Ext. of Ergot, sufficient to make,. .4 ounces. 
Mix and give from a half to a teaspoonful four times 
a dav. 

In teaspoonful doses it increases labor pains, but 
should not be given in these cases unless the mouth of 
the womb is dilated and the presentation normal. 



POLYTRICHUM. 521 

RHUS AROMATICA. 

FRAGRANT SUMACH. 

Rhus Aromatica is hemostatic, astringent, and tonic. 
It is very efficient in hemorrhage from the lungs, stomach, 
and kidneys, however, it is rarely given alone but usually 
in combination with Ergot. It is one of our most efficient 
remedies in the treatment of nocturnal incontinence 
of urine in children; and in the incontinence of urine 
in the aged. It is useful in diabetes mellitus and also 
in diabetes insipidus. See Ergot. 

The dose of the Fl. Ext. of Rhus Aromatica is from 
10 drops to a drachm. 

BAROSMA BETULINA. 

BUCHU. 

Buchu is a stimulating diuretic, and renders the urine 
more or less antiseptic. It is useful in subacute inflam- 
mation and irritability of the bladder and may be given 
in all diseases where there is scantiness of urine. The 
dose of the Fl. Ext. of Buchu is from \ to 1 drachm. 
POLYTRICHUM. 

HAIR-CAP MOSS. 

Polytrichum is an unirritating hydragogue diuretic 
and may be used in acute nephritis after the more acute 
symptoms have subsided. It is an efficient remedy in 
dropsical conditions arising from diseases of the liver or 
kidneys. Its use has been known to remove as much 
as forty pounds of urine from a dropsical patient in 
twenty-four hours. It is said to be useful in gonorrhoea 
and irritation of the bladder. . 



522 THE PRACTICE OF MEDICINE. 

The dose of the Fl. Ext. of Polytrichum is from i to 
2 drachms every four hours or three or four times a day. 
APOCYNUM CANNABINUM. 

CANADIAN HEMP. 

Apocynum is a heart-stimulant and tonic and also a 
valuable stimulating diuretic. In large doses it acts ' as 
a hydragogue cathartic and an emetic. In dropsical 
conditions with pumness of the face, feet, ankles, or hands, 
followed by general dropsy, and in oedema of the feet 
and ankles during pregnancy, it is one of the most efficient 
remedies known to this writer. It is almost specific in 
coughs attended by the expectoration of a watery material 
and swelling, or pumness of the face, feet or hands. 

The dose of the Fl. Ext. of Apocynum Cannabinum 
is 3 or 4 drops three or four times a day. 
HYDRANGEA. 

Hydrangea is a diuretic and is thought to possess the 
power of checking the formation of renal or cystic calculi. 
It is useful in irritation of the kidneys, bladder and 
urethra; and in cases of gravel it exerts a soothing and 
alterative effect on the entire urinary tract. 

The dose of the Fl. Ext. of Hydrangea is from \ to 2 
drachms every four hours or three or four times a day. 
CHIMAPHILA. 

PIPSISSEWA. 

Chimaphila, is a diuretic and is useful in pyelitis and 
inflammation of the bladder after the more active symptoms 
have subsided. It is a useful remedy in dropsy and 
enlargement of the lympathic glands, 



STIGMATA MAYDIS. 523 

The dose of the Fl. Ext. of Chimaphila is from J to 2 
drachms every four hours or three or four times a day. 

COPAIBA. 

BALSAM OF COPAIBA. 

Copaiba is a stimulating diuretic and is useful in 
pyelitis, cystitis and gonorrhoea, however, it should not 
be used until the more acute symptoms have subsided to 
some extent. It is also useful in subacute and chronic 
bronchitis with profuse purulent expectoration. It is 
also a useful remedy as a stimulant application, in indolent 
ulcers. 

The dose of the Balsam of Copaiba is from 10 grains 
to a drachm, in capsules three or four times a day. 

ASCLEPIAS SYRIACA. 

SILKWEED. 

Asclepias Syriaca is a stimulant diuretic and may be 
used in inflammation of the kidneys, bladder and urethra, 
after the more acute symptoms have subsided. 

The dose of the Fl. Ext. of Asclepias Syriaca is from 
10 to 30 drops four or five times a day or oftener. 

STIGMATA MAYDIS. 

CORN-SILK. 

Corn-Silk is diuretic, demulcent, and antiseptic, and 
is one of our most efficient remedies in inflammation of 
the bladder. 

The dose of the Fl. Ext. of Stigmata Maydis is from 
J to 2 drachms four or five times a day. 



524 THE PRACTICE OF MEDICINE. 

LITHII CITRAS. 

CITRATE OF LITHIUM. 

Citrate of Lithium is said to be efficient in preventing 
the formation of calculi in the kidneys and bladder. 

The dose is from 5 to 20 grains three or four times a 
day. 

POTASSII ACETAS. 

ACETATE OF POTASH. 

Acetate of Potash is an alkaline diuretic and may 
be used in all fevers and inflammations, except when 
the urine is already alkaline, where there is scantiness 
of urine. 

The dose is from 15 to 60 grains largely diluted with 
water, every four hours. 

PILOCARPUS. 

JABORANDI. 

Jaborandi is sudorific, sialagogue, and diuretic. It 
depresses the heart and lowers the temperature. It is 
a valuable remedy in oedema of the glottis and in uraemia. 
In these cases on account of the unreliability of its Fluid 
Extract one of its alkaloids, the Hydrochlorate of Pilo- 
carpine, is usually given. It produces profuse perspiration 
and a free flow of saliva. The remedy is a very active 
one, therefore, care must be exercised in its use. 

The dose of the Fl. Ext. of Jaborandi is from 20 to 
60 drops; and the dose of the Hydrochlorate of Pilocarpine 
is from 1-12 to 1-2 of a grain, hypodermically, 1-6 of a 
grain. 



BAPTISIA TINCTORIA. 525 

ECHINACEA ANGUSTIFOLIA. 

CONE FLOWER. 

Echinacea is alterative and antiseptic and probably 
a stimulant to the entire glandular system. In typhoid 
fever, septic and pyaemic conditions it is one of our most 
efficient remedies. It has been used with success in 
syphilis; and is an efficient local application in chancre, 
chancroid, anthrax, erysipelas, etc. Given internally and 
applied freely to the wound it is practically a specific in 
poisonous bites and stings. Beneficial results are claimed 
for it in tetanus, hydrophobia, diphtheria, and cerebro- 
spinal meningitis. That it has the power, when its 
administration is commenced early, of aborting typhoid 
fever is claimed by many reputable physicians. It may 
be used externally in from 25 to 50 per cent solutions or 
full strength. It appears to be non-poisonous. 

The dose of the Fl. Ext. of Echinacea is from 10 to 
30 drops every hour or two to three or four times a day. 

BAPTISIA TINCTORIA. 

WILD INDIGO. 

Baptisia is an antiseptic and may be used in typhoid 
or other fevers where the tongue and mucous membranes 
are dry and of a dark-red or purplish color. Locally it 
may be used as a gargle in sore throat and as a douche in 
nasal catarrh. In these cases a 25 to 50 per cent solution 
of the Fluid Extract of it is the proper strength to be used. 

The dose of the Fl. Ext. of Baptisia is from 1 to 5 
drops every one or two hours. 



526 THE PRACTICE OF MEDICINE. 

NAPHTHALIN. 

Naphthalin is an antiseptic and is an excellent remedy 
in typhoid fever and diarrhoea. It is also efficient in 
preventing fermentation of the contents of the stomach. 

The following is also efficient in scabies and ringworm: 

Naphthalin, i drachm, 

Vaseline, i ounce. 

Mix and apply two or three times a day. 

The dose of Naphthalin is from 2 to 10 grains every 
four or six hours. It is best given in capsules combined 
with an equal amount of Sugar of Milk. 

SALOL. 

Salol is antiseptic, antipyretic and germicide. It 
depresses the heart's action, lowers temperature, and 
produces profuse sweating. It is an efficient antiseptic 
in typhoid fever where there is a high fever with a full, 
strong pulse. It is said to be efficient in duodenal catarrh; 
jaundice caused from an inflammation of the bile ducts; 
the bilious form of sick-headache; and in some forms of 
neuralgia. It is said to be efficient in rheumatism and a 
disinfectant in catarrh of the bladder. We do not think 
very much of it as a remedy. 

The dose of Salol is from 5 to 60 grains, in capsules, 
every four or six hours. We do not recommend the 
large doses. 

SODII SULPHIS. 

SULPHITE OF SODA. 

Sulphite of Soda is an antiseptic and antacid. It 
is one of our most efficient remedies in all fevers, 



ACIDUM CARBOLICUM. 527 

or other diseases, where there is a broad pallid tongue 
uniformly coated with a dirty, whitish, pasty fur, how- 
ever, its administration should be discontinued as soon 
as the fur is removed from the tongue or the color of the 
tongue is changed. It makes an efficient wash in 
aphthous sore mouth; and also in foul-smelling ulcers. 
The dose of Sulphite of Soda is from 10 to 20 grains 
every three or four hours. 

ACIDUM CARBOLICUM.— 95 per cent. 

CARBOLIC ACID. 

Carbolic Acid is antiseptic and germicide. A solution 
of 1 to 1,000 prevents the development of most bacteria. 
It is an efficient remedy in irritation of the stomach; and 
combined with Iodine makes a very efficient antiseptic 
in typhoid fever, thus: 

Carbolic Acid, \ drachm, 

Tr. of Iodine, 1 drachm, 

Powd. Gum Arabic, 1 drachm, 

Water, sufficient to make, 4 ounces. 

Mix and give a teaspoonful every four or six hours. 
A 5 per cent, solution of Carbolic Acid is efficient for 
disinfecting soiled clothing and the various discharges. 
The following is an efficient antiseptic application for 
burns, sores, wounds or erysipelas: 

Carbolic Acid, 1 ounce, 

Gum Camphor, 1 ounce, 

Alcohol, \ ounce, 

Glycerine, \ ounce, 

Olive Oil, 3 ounces. 



528 THE PRACTICE OF MEDICINE. 

Mix and apply as often as is necessary. If it appears 
to be too strong add -more Olive Oil. The following 
makes an efficient salve: 

Carbolic Acid, 5 drops, 

Vaseline, 1 ounce. 

Mix thoroughly and apply three or four times a day. 
A solution of Carbolic Acid is efficient in relieving itching 
of the various parts of the body. 

The dose is from \ to 2 drops of a 95 per cent solution, 
which is always meant when the remedy is referred to in 
this work. 

TEREBINTHINA. 

SPIRITS OF TURPENTINE. 

Turpentine is antiseptic, diuretic, anthelmintic and 
rubefacient. In typhoid or other low forms of fever, it 
is one of our most efficient antiseptics. Where the tongue 
is red and dry or brown and appears as if it had been 
glazed and especially if the abdomen is tympanitic, 
Turpentine should be given. The dose should be small, 
not more than 2 or 3 drops every three or four hours. 
It is best given in starch-water. 

It is an efficient counter-irritant; and for this purpose, 
it may be used by means of flannel cloths saturated with 
it. In peritonitis, dysentery, etc., a tablespoonful of it may 
be added to a quart of hot water and cloths wrung out 
of this applied to the bowels. These applications may 
also be used in typhoid fever when the bowels are swollen. 
In combination with other articles it makes a valuable 
liniment. 



IODOFORM. 529 

The dose of Spirits of Turpentine is given in standard 
medical works from 5 to 15 drops; and as an anthelmintic 
\ ounce, but the dose we would recommend is from 1 to 
5 drops every four hours. We believe that large doses 
of it are injurious. 

ACIDUM HYDROCHLORICUM. 

HYDROCHLORIC OR MURIATIC ACID. 

Hydrochloric Acid is an antiseptic and overcomes 
excessive alkalinity of the system. It is an efficient remed} 
in typhoid or other low forms of fever where the tongue 
and mucous membranes are redder than natural or red 
and dry. 

It may also be used in doses of 3 or 4 drops, largely 
diluted with water, half an hour before each regular meal 
to overcome acidity of the stomach; or if there is a 
deficiency of acid in the stomach it may be given after 
meals. 

The dose is from 2 to 5 drops well diluted every three 
or four hours. 

IODOFORM. 

Iodoform is alterative and antiseptic. Its antiseptic 
properties are limited, however, it is a valuable dressing 
for infected wounds, chancroid, ulcers, etc. In the form 
of Iodoform Gauze it makes an excellent packing for 
deep wounds, sinuses, fistulae, and the vaginal, rectal and 
nasal cavities. It is our very best dressing for recent 
wounds of almost every description. The only objection 
to it is its offensive odor. 



530 THE PRACTICE OF MEDICINE. 

It is an efficient remedy in dysentery with ulceration 
of the bowels which may be known by the appearance 
of pus in the discharges from the bowels. In these cases 
it may be given, combined' with Bismuth, in doses of one 
or two grains every three or four hours. 

The dose of Iodoform is from i to 3 grains every three 
or four hours. 

ACIDUM BORICUM. 

BORACIC ACID. 

Boracic Acid is an antiseptic; and in solution of 10 
or 15 grains to the ounce of sterilized water it has a wide 
range of usefulness „in inflammatory diseases of the eyes, 
nose, throat and bladder. Insufflations of Powd. Boracic 
Acid are very valuable in otorrhcea, however, care should 
be used in these cases, to prevent clogging of the outflow 
of pus, etc. It is also valuable in superficial burns. 

In pruritus, or itching, the following usually affords 
prompt relief: 

Boracic Acid, 40 grains, 

Carbolic Acid, 20 drops, 

Glycerine, \ ounce, 

Water, sufficient to make, 4 ounces. 

Mix and apply to the part frequently. 

The following makes a valuable dusting powder: 

Boracic Acid, 2 drachms, 

Salicylic- Acid, 24 grains, 

Powd. Starch, 4 drachms. 

Mix and use as required. 



PLUMBI ACETAS. 531 

BISMUTHI SUBNITRAS. 

SUBNITRATE OF BISMUTH. 

Subnitrate of Bismuth is astringent and antiseptic; 
and when taken into the stomach acts on this organ as 
a sedative and antacid. It is one of our very best remedies 
in irritable conditions or inflammation of the stomach 
and bowels. In gastric ulcer and diarrhoea it is one of 
our most efficient remedies. Even cancer of the stomach 
may be temporarily relieved by it. It is practically non- 
poisonous. 

The dose is from 5 to 60 grains every one, two or three 
hours. 

ZINCI SULPHOCARBOLAS. 

SULPHOCARBOLATE OF ZINC. 

Sulphocarbolate of Zinc is astringent and antiseptic. 
It is an efficient remedy in diarrhoea and dysentery and 
may be combined with Bismuth. A solution of it, 5 
grains to the ounce, makes an efficient throat or mouth- 
wash; and 2 J or 3 grains to the ounce of water makes an 
efficient injection in gonorrhoea. 

The dose is 2 to 3 grains every three or four hours. 

PLUMBI ACETAS. 

SUGAR OF LEAD. 

Sugar of Lead is an astringent and as such it is useful 
in hemorrhage from the stomach, diarrhoea, conjunctivitis,- 
gonorrhcea, etc. In diarrhoea it is usually combined 
with Opium. As an eye-water, or a wash in gonorrhoea, 
the solution is made of from 1 to 5 grains of it to the 
ounce of water. 



532 THE PRACTICE OF MEDICINE. 

The following is useful in bruises, sprains, superficial 
inflammations and erysipelas: 

Sugar of Lead, ; . . i drachm, 

Laudanum, i ounce, 

Water, sufficient to make, 8 ounces. 

Mix and apply frequently. 

The dose of Sugar of Lead is from J to 5 grains every 
three or four hours. 

ACIDUM TANNICUM. 

TANNIC ACID ; TANNIN. 

Tannin is astringent and styptic. It is efficient in 
checking hemorrhage from external surfaces. In these 
cases it should be applied in the form of a saturated 
solution. Injected into the nose it is also efficient in 
controlling hemorrhage from this source. It ' is efficient 
in controlling hemorrhage from the stomach. In these 
cases it should be given in the form of a powder, in full 
doses. 

Either alone or combined with Bismuth it is efficient 
in checking diarrhoea. 

The dose of Tannin is from 1 to 10 grains every one, 
two, or three hours. 

ARGENTUM. 

SILVER. 

Nitrate of Silver, or " Caustic," when applied to the 
skin, pure, it acts as a superficial escharotic producing 
a slough, which, on exposure to light turns black. When 
administered internally it is an astringent and germicide. 
The prolonged use of Silver, internally, produces a dark 



CUPRI SULPHAS. 533 

discoloration of the skin, which is permanent. It is an 
efficient remedy in ulcer of the stomach and chronic 
diarrhoea. 

In solution of 10 to 40 grains to the ounce it is a very 
useful application in inflammation or ulceration of the 
mouth; or instead of the solution the solid stick may be 
employed. In purulent conjunctivitis a solution containing 
from 3 to 5 grains to the ounce is the very best treatment. 
It should be applied with a camel's hair pencil. Copious 
irrigations of the urethra with a warm solution, 1 to 10,000 
of the Nitrate of Silver is very beneficial in gonorrhoea 
In chronic diarrhoea and dysentery copious injections into 
the bowel of a solution containing 10 to 30 grains to the 
pint is often very beneficial. 

The Nitrate and also the Oxide of Silver have been 
used with good results in locomotor ataxia, epilepsy, and 
chorea, but their use in these diseases is now condemned, 
however, should other treatment fail they may be used. 

The dose of the Nitrate of Silver is from J to \ grain 
three or four times a day. 

The dose of the Oxide of Silver is from \ to 2 grains, 
three or four times a day. 

CUPRI SULPHAS. 

BLUE vitriol; blue stone. 

Blue Stone, in small doses, is an astringent; in large 
doses, an emetic. Combined with Opium it is sometimes 
very efficient in obstinate chronic diarrhoea. It is an 
efficient antidote in Phosphorus poisoning, forming an 
insoluble coat over the phosphorus. 



534 THE PRACTICE OF MEDICINE. 

In indolent ulcers, ulcerative inflammations of the 
mouth and chronic granular conjunctivitis (trachoma) 
the lids should be penciled with the solid crystals of Blue 
Stone. As an injection in gonorrhoea, after the more acute 
symptoms have subsided, 2 grains to the ounce of water 
is efficient. 

The dose, as an astringent, is from J to 1 grain three 
or four times a day. As an emetic the dose is from 6 to 
12 grains, but it is too irritating to be used for this purpose. 

MYRICA CERIFERA. 

BAYBERRY-BARK. 

Myrica Cerifera is an unirritating, stimulating mucous 
astringent, and in diarrhoea and dysentery is one of our 
very best remedies. It is rarely ever given alone but in 
combination with other remedies, as follows: 

Fl. Ext. of Bayberry, \ ounce, 

Subnitrate of Bismuth, i.J drachms, 

Paregoric, sufficient to make, 2 ounces. 

Mix, put it in a large-mouth vial, and give a teaspoonful 
every one, two, or three hours as is required, or: 

Powd. Bayberry, 4 drachms, 

Sulphocarbolate of Zinc, 48 grains, 

Subnitrate of Bismuth, i\ drachms, 

Naphthaline, 16 grains. 

Mix thoroughly and divide into sixteen powders and 
give one every three or four hours as is needed. 

An infusion or a strong solution of Bayberry makes 
an efficient gargle or mouth-wash. 



CADMII SULPHAS. 535 

The dose of Powd. Bayberry is from 10 to 30 grains; 
and the dose of the Fl. Ext. is from 10 to 30 drops every 
one, to four hours. 

ZINCI OXIDUM. 

OXIDE OF ZINC. 

The Oxide of Zinc is an astringent and is very useful 
in checking night-sweats. The Oxide of Zinc Ointment 
is useful in acute skin affections, and, when the following 
is added to it, it makes a valuable local application for 
fever-blisters (herpes), burns, eczema, erysipelas, etc.: 

Carbolic Acid, \ drachm, 

Oil of Cade (Younkin's), 1 drachm, 

Oxide of Zinc Ointment, 1 ounce. 

Mix and apply three or four times a day. 
The dose of the Oxide of Zinc is from 1 to 5 grains 
three or four times a day. 

ZINCI SULPHAS. 

SULPHATE OF ZINC. 

Sulphate of Zinc is an astringent and in large doses 
an emetic. In solution of from 1 to 2 grains to the ounce 
it makes an efficient eye-water. In solution of \ 
grain to the ounce, gradually increased to 5 or 6 grains, 
it is efficient in gonorrhoea and leucorrhcea. 

Its internal use is not recommended in this work. 

CADMII SULPHAS. 

SULPHATE OP CADMIUM. 

Sulphate of Cadmium is an astringent. It makes 
an excellent eye- water in solution of 2 grains to the ounce. 



536 THE PRACTICE OF MEDICINE. 

It is efficient in removing opacity of the cornea. It is 
not used internally. 

PINUS CANADENSIS. 

HEMLOCK SPRUCE. 

Pinus Canadensis is an astringent and may be used 
where the effects of Tannin is desired. It makes an 
efficient throat-wash either diluted or the Fl. Ext. in full 
strength. A solution of it may be used in leucorrhcea, 
gonorrhoea, and gleet. In these cases, it may be used in 
the strength of i ounce to 6 or 8 of water. 

The dose of the Fl. Ext. of Pinus Canadensis is from 
io to 30 drops every three or four hours. 
HAMAMELIS. 

WITCH-HAZEL. 

Hamamelis is an astringent, and is recommended in 
varicose veins and hemorrhoids. In the latter, it is used 
as a wash and in the former it is taken internally. It 
has a popular reputation as a topical remedy in sprains, 
bruises and small wounds. 

The dose of the Fl. Ext. of Hamamelis is from 10 to 
60 drops three or four times a day. 

OPIUM. 

Opium is analgesic, hypnotic, diaphoretic, narcotic, 
and antispasmodic. It is used to relieve pain; check 
cough; produce sleep; to check excessive discharges from 
the bowels; and to control the peristaltic action of the 
intestines in dysentery or other diseases. It is our most 
efficient remedy in colic, whether it is hepatic, stomachic, 
intestinal or renal; and it relieves convulsions after all 



MORPHINE SULPHAS. 537 

other remedies have failed. It is also our very best remedy 
with which to quiet an irritable stomach; but in these cases, 
it should be given in the form of the Sulphate of Morphine. 

All forms of Opium are badly borne by young children, 
and, if given to them at all, it should be in doses far less 
than the proportionate dose of other drugs for their 
respective ages. 

The dose of the Gum or Powd. Opium is from. J to 
2 grains not oftener than every four or six hours. 

MORPHINE SULPHAS. 

SULPHATE OF MORPHINE. 

Morphine has a similar effect to that of Opium. It 
is our most efficient remedy in the treatment of the vari- 
ous forms of colic. It usually relieves the paroxysms of 
asthma promptly; and is the very best treatment for cholera 
and cholera morbus. It is usually efficient in irritable con- 
ditions of the stomach; and relieves convulsions when all 
other remedies have failed. Loomis says that it is 
the best treatment in ursemic poisoning. The addition, 
to each dose, of i-iooof a grain of the Sulphate of Atropine 
makes it more efficient in relieving pain and lessens the 
danger of poisoning. It is far more prompt and efficient 
in its action when given hypodermically. In using it 
hypodermically give from the -g- to the J of a grain and 
if the patient is not relieved in twenty or thirty minutes 
repeat the dose, then do not give another dose of it under 
three or four hours. 

The dose of the Sulphate of Morphine is from J to J 
of a grain not oftener, after the second dose, which may 



538 THE PRACTICE OF MEDICINE. 

be given in thirty or forty minutes, than every three 
or four hours. 

TR. OF OPIUM. 

LAUDANUM. 

Laudanum is the Tr. of Opium and has the same 
effects as the Gum or Powd. Opium. 

One drop of Laudanun has produced death in a child 
one day old. 

The dose of Laudanum is from 10 to 20 drops not 
oftener than from four to six hours. 

TR. OPII CAMPHORATA. 

PAREGORIC. 

Paregoric contains Camphor, Benzoic Acid, Oil of 
Anise and about 2 grains of Powd. Opium per ounce. 
It is an efficient remedy. 

The dose of Paregoric is from § to 4 drachms every 
three or four hours. 

PULVIS IPECACUANHA ET OPII. 
Dover's powder. 

Dover's Powder contains 10 per cent of Powd. Opium; 
10 per cent of Powd. Ipecac; and 80 per cent of Sugar 
of Milk. On account of the Ipecac it is more diaphoretic 
than the other forms of Opium. Combined with Quinine, 
a 10 grain dose of each, and a hot foot-bath before retiring 
at night is efficient in breaking a cold. Dover's Powder 
is also efficient in controlling after-pains. 

The dose is 10 grains or less, every three or four hours. 



LOBELIA INFLATA. 539 

CODEINA. 

CODEINE. 

Codeine has effects similar to the other forms of Opium, 
however, it is less constipating. It, as well as other forms 
of the drug, has been given with good results in diabetes 
mellitus. Codeine is sometimes added to cough syrups 
with advantage. 

The dose of Codeine is from 1-5 to 1 grain every 
three or four hours; or in diabetes mellitus, 2 grains three 
times a day. 

CHLORAL. 

HYDRATE OF CHLORAL. 

Chloral is hypnotic, producing quiet, natural sleep. 
Large doses depress the heart. It is efficient in controlling 
uraemic and puerperal convulsions; and, combined with 
Bromide of Potash, is probably our best antispasmodic 
in the treatment of tetanus and Strychnine-poisoning. 

Chloral is almost a specific in nettle rash; and com- 
bined with Quinine it prevents this drug from pro- 
ducing a rash on the skin in persons possessing this 
idiosyncrasy. 

The dose of Chloral is from 10 to 20 grains, in Mint- 
Water, every hour until the desired results are obtained 
or until two or three doses are given. 

LOBELIA INFLATA. 

LOBELIA. 

Lobelia is expectorant, antispasmodic, and in large 
doses emetic. It is our very best expectorant. Where 
the cough is loose and the expectoration profuse, small 



540 THE PRACTICE OF MEDICINE. 

doses of it should be given, but where the cough is 
harsh and the expectoration scant, larger doses of it should 
be given. It is almost a specific for croup. In these 
cases, from 10 to 20 drops of the Tr. should be given 
every five or ten minutes until relief is obtained or vomiting 
produced. In a great majority of cases of croup, an 
attack may be prevented by giving a full dose of the drug 
as soon as symptoms of the disease are discovered. 
Frequently children after being placed in bed at night, 
cough so incessantly that they cannot sleep nor allow 
any one else to do so. In these cases, a full dose of the 
Tr. of Lobelia quiets the little fellow's cough for the 
night. 

The following is one of our most useful cough syrups : 

Tr. of Lobelia, 1 drachm, 

Fl. Ext. of Ipecac, 16 drops, 

Syrup of Wild Cherry, sufficient to make, . 2 ounces. 

Mix and give a teaspoonful every three or four 
hours. 

This prescription is especially useful in whooping-cough. 

In difficult labor from a rigidity of the mouth of the 
womb, Lobelia is an efficient remedy. In these cases 
it may be given in frequently repeated doses until nausea 
is produced. . It is also an efficient remedy in hysterical 
convulsions, also in Rhus Toxicodendron poisoning. The 
dose of the Tr., in coughs, is from 2 to 6 drops every 
three or four hours; in croup and rigid os, it is from 10 
to 30 drops every few minutes until relief is obtained or 
vomiting produced. 



AMMONII CHLORIDUM. 541 

IPECACUANHA. 

IPECAC. 

Ipecac is expectorant, emetic and in small doses anti- 
emetic. In the form of the Syrup or the Fl. Ext. it is 
a very efficient expectorant and relieves croup promptly. 
In these cases, it may be given in from 5 to 10-drop 
doses every few minutes until relief is obtained or 
vomiting produced, and from 1 to 4 drachms of the 
Syrup may be used in the same manner. 

The Fl. Ext. in doses of \ drop every hour is efficient 
in quieting an irritable stomach. It is an efficient remedy 
in dysentery. In these cases, it should be given in an 
amount just short of producing nausea. 

The dose of the Fl. Ext., is from 1 to 5 drops, as an 
expectorant; as an emetic, 20 drops; the Syrup, from 2 
to 4 drachms; and of Powd. Ipecac, as an expectorant, 
from 1 to 5 grains, as an emetic 20 grains. 

SYRUPUS PRUNI VIRGINIANS. 

SYRUP OF WILD CHERRY. 

Wild Cherry is tonic and a feeble nerve-sedative. 
Its greatest use is as a vehicle for unpalatable drugs. 
The dose is from J to 1 drachm as often as is required. 

AMMONII CHLORIDUM. 

CHLORIDE OF AMMONIA. 

Chloride of Ammonia is a stimulant expectorant and 
may be used in chronic bronchitis, or other diseases 
where the matter expectorated is profuse. 

The following is excellent in these cases: 



542 THE PRACTICE OF MEDICINE. 

Chloride of Ammonia, 4 drachms, 

Fl. Ext. of Squill, 2 drachms, 

Tr. of Toiu, 1 ounce, 

Syrup of Wild Cherry, sufficent to make, . . 4 ounces. 
Mix and give a teaspoonful every three or four hours. 

GRINDELIA ROBUSTA. 
Grindelia Robusta is efficient in the treatment of 
asthma and other coughs of an explosive character. It 
is said to be an antidote to Rhus poisoning. In these, 
cases, an ounce of the Fl. Ext. may be added to a pint of 
water and the parts kept wet with it by means of cloths. 
The dose of the Fl. Ext. of Grindelia Robusta is from 
15 to 60 drops every three or four hours, to three times 
a day. 

SPIRITS OF CHLOROFORM. 

Chloroform is an anesthetic, sedative, carminative, 
and anthelmintic. When administered for the purpose 
of producing anaesthesia it is administered by inhalation. 
Chloroform is useful in colic, whether hepatic, gastric, 
intestinal or renal. In hepatic and renal colic it may be 
necessary to give it by inhalation. It is an efficient 
remedy in the colic of young children. 

The dose is from 20 to 60 drops, well diluted, every 
half-hour or so. Judgement must be exercised in its use, 
especially by inhalation. 

COCAINE HYDROCHLORAS. 

HYDROCHLORATE OF COCAINE. 

Cocaine in solution of from 4 to 6 per cent is a very 
efficient local anaesthetic, especially to mucous membranes. 



GRINDELIA SQUARROSA. 543 

It is a very efficient remedy in quieting an Writable 
stomach. 

The dose is from J to 2 grains every one, two or three 
hours, however, small doses should be given in irritation 
of the stomach. 

POLYMNIA UVEDALIA. 

BEARSFOOT. 

Polymnia Uvedalia is one of our very best remedies 
in enlargement of the spleen of malarial origin. It is 
also efficient in enlargement of the liver and inflammation 
and enlargement of the lympathic glands. The Fl. Ext. 
of it is used internally, and an ointment of it is used extern- 
ally, especially in enlargement of the lympahtic glands. 

The dose of the Fl. Ext. of Polymnia Uvedalia is 15 
drops three times a day after meals. 

GRINDELIA SQUARROSA. 

Grindelia Squarrosa and Grindelia Robusta belong to 
the same natural order, composite, but this by no means 
proves that their effects are the same. The Jamestown 
weed, tobacco, belladonna, tomatoes and potatoes belong 
to the same natural order, solanacea, but their effects 
are entirely different and it is just so with Grindelia 
Squarrosa and Grindelia Robusta. 

Grindelia Squarrosa is one of our most efficient remedies 
in enlargement of the spleen, especially where it is of 
malarial origin. It is usually combined with Polymnia 
Uvedalia. 

The dose of the Fl. Ext. is 30 drops three times a day 
after meals. 



544 



THE PRACTICE OF MEDICINE. 



OLEUM RICINI. 

CASTOR OIL. 

Wherever the word Oil, without a qualifying word, 
is used in this book Castor Oil is meant. 

MAGNESIA SULPHAS. 

EPSOM salts; salts. 

Wherever the word Salts occurs in this book, without 
a qualifying word, Epsom Salts is meant. 
POISONS AND ANTIDOTES. 

ACIDS. 

Alkalies, Bicarbonate of Soda, 
Chalk; induce vomiting, then, 
give raw eggs, fixed oils, milk, 
or other bland liquids. 

Chalk in suspension. Induce 
vomiting, then, give bland 
liquids. 

Dilute Aqua Ammonia, Iron, 
Chloride or Citrate in solution. 
Induce vomiting, then, give 
stimulants. 

Alcohol, the best, Sodium, 
or Salts, mucilage. Induce 
vomiting, then, give stimulants. 



Hydrochloric. 

Nitric. 

Sulphuric. 



Oxalic. 



Prussic. 



Carbolic. 



ALKALIES. 

Ammonia. 
Caustic Soda. 
Caustic Potash. 
Lye. 



Vinegar, lemon-juice, or other 

dilute acids, fixed oils. Induce 

vomiting, then, give bland 
liquids. 



POISONS AND ANTIDOTES. 



545 



Induce vomiting, or use the 
stomach tube, then, give the 
arsenic. Hydrated Oxide of Iron, Dial- 

yzed Iron, Salt, Castor Oil or 
Ammonia. 
Salts or Sulphate of Soda, 
sugar of lead. Dilute Sulphuric Acid. Induce 

vomiting, then, give Oil and 
bland liquids. 
Corrosive Sublimate. Induce vomiting, then, give 
Tartar Emetic. raw eggs, Oil, Tannin. 

Induce vomiting, then, give 
raw eggs, milk and other bland 
liquids. 

Induce vomiting, then, give 
Salts, Sulphate of Copper, old 
Oil of Turpentine. 

Large quantities of salt-water, 
bland liquids. 

Induce vomiting, then, give 
starch and water repeatedly. . 

Induce repeated vomiting or 
use the stomach tube. Give 
Atropine and Permanganate of 
Opium. Potash hypodermically. Strong 

Morphine. coffee by mouth and also by 

rectal injection. Keep the pa- 
t'ent awake and if necessary 
employ artificial respiration. 



Blue Vitriol 
Verdigris. 



Phosphorus. 



Silver titrate. 



Iodine. 



546 



THE PRACTICE OF MEDICINE. 



Chloral. 



Strychnine. 

Aconite. 

Belladonna. 

Tobacco. 

Stramonium. 

Ptomains. 



Induce vomiting, give Aromatic 
Spirits of Ammonia, Strychnine, 
Nitroglycerine. 

Induce vomiting, then, give 
Bromide of Potash and Chloral 
and keep the patient quiet. 

Emetics, Oil, Salts, Strych- 
nine, Nitroglycerine, Whiskey, 
Aromatic Spirits of Ammonia 
and other stimulants. 






TABLE OF DOSES. 
THE DOSE OF MEDICINE. 



547 



In prescribing for children under twelve years of age the 
following rule of Dr. Young is sufficiently accurate: Add 12 
to the number representing the age of the child, in years, 
and divide the latter number by the result. Thus, a child 
two years old requires (2 (age) +12=14. 2-^14=-^- or -f), one- 
seventh of an adult dose; a child of three years, one-fifth, 
thus: 3+12=15. 3^-15=^, or one-fifth of the adult dose. 
TABLE OF DOSES. 



NAMES 

OF 

MEDICINES. 


MONTHS. 


YEARS. 




Pu 

CO 


O 


00 
O 

H 

to 


H 

O 

Oo 


O 


OO 

r-t- 
O 

H 

to 


H 

to 

O 

1— 1 


H 

Os 

O 

to 




THE 

AM'T 


Acid, Aromatic Sulphuric. . 


2 


I 


i* 


2 


4 


6 


IO l6 


drops. 


Acid, Carbolic 


1 
11 


1 


1 

TT 


1 
8 


1 
5 


1 
3 


f i I 




Acid, Hydrochloric 


3 


1 
5 


1 
4 


3 

8 


3 

5 


1 


2 ! 3 




Acid, Dilute Nitric 


\ 


I 


I 


2 


3 


4 


7 


IO 




Acid, Sulphurous. ...... 


x\ 


2 


2* 


4 


12 


15 


18 


30 




Aconite Root, Tr. of 


1 
1 8 


1 
TT 


* 


1 
4 


2 


§ 


ii 


2 




Acetanilide 


1 
3 6 


1 
3 


1 

1 2 


I 


ii 


2 | 3l 


5 


grs. 


Ammonia, Aromatic Spirits. . . 


ii 


2 


2§ 


4 


12 


16 


18 


30 


drops. 


Ammonia, Carbonate of 


3 

1 6 


1 


I 


2 


3 


4j 7 


IO 


grs. 


Ammonia, Chloride of. ... 


3 

1 6 


I 


I 


2 


3 


4 i 7 


10 


tt 


Amygdalus Per., Fl. Ext. of. . . . 


1 
8 


2 
TT 


1 

6 


1 
4 


2^ 
5 


§ |ii 


2 


drops. 


Apocynum Can., Fl. Ext. of. 


3 


tV 


1 
4 


3 

8 


3 
5 


1 i 2 


3 


u 


Apomorphine, Hydrochlorate of. . 






1 

10 


1 
4 5 


1 


Mi' 

"2TF 1 T~5 


1 


E r - 


Arsenic, Fowler's Solution of. 


3 


4 


i 


1 


3 

5 


i§ 


2 


3 


drops. 


Asclepias Syriaca, Fl. Ext. of. . . 


I 


2 


3 


4 


6 


10 


20 


30 


n 


Atropine, Sulphate of 




1 


1 


1 


1 


1 


1 




8 




1200 


5 


3 


200 


15 


1 


g r - 


Baptisia Tinctora, Fl. Ext. of. . . 


1 

T 


1 

6 


i 


2 
"5" 


§ 


i| 


2 


drops. 



548 



THE PRACTICE OF MEDICINE. 



NAMES 
OF 

MEDICINES. ' 


MONTHS. 


YEARS. 




Oo 


4*> 

r-r- 
O 


oo 

r-N 

o 

H 

.to 


o 


O 


00 

o 

H 

to 


H 

to 

o 

M 


M 

On 

O 
to 




THE 
AM'T 


Bayberry, Powdered 


I 


i* 


2 


4 


6 


8 


i5 


20 


grs. 


Bayberry, Fl. Ext. of. . . 


I 


i* 


2 


4 


6 


8 


i5 


20 


drops. 


Bearsfoot, Fl. Ext. of 


1 

2 


I 


ii 





5 


6 


IO 


15 


a 


Belladonna, Fl. Ext. of 


1 

1 8 


l 

TT 


1 

TT 


1 

8 


i 


i 

3 


2 
3 


I 


a 


Bismuth, Subnitrate of 


1 
2 


1 


I 


2 


3 


4 


7 


IO 


grs. 


Bucliu, Fl. Ext. of 


I 


2 


3 


4 


6 


IO 


20 


30 


drops. 


Cactus Grandiflorus, Fl. Ext. of. . 


1 
8 
1 
4 


2 
T5~ 


i 

6 


1 

4 


2 


1 


ii 


2 • 


a 


Caffeine, Citrate of 


1 

3 


1 
2 


I 


i| 


2 


3i 


5 


grs. 


Calcium, Sulphide of. - - - - - 


1 

8 

1 

4 

I 


2 
1 5 


1 

6 


1 
4 


2 
5 


4. 


ij 


2 


a 


Calomel 


1 
2 


1 
2 


I 


I 


I 


I 


1 


g r - 


Camphor, Spirits of 


i* 


2 


4 


6 


8 


i5 


20 


drops. 


Camphor, Gum of. 


3 

TT 


1 
5 


1 
4 


3 

8 


3 


i 


2 


3 


grs. 


Camphorated Tr. of Opium. 


2 


4 


5 


7 


12 


20 


40 


60 


drops. 


Cascara Sagrada, Fl. Ext. of. . 


I 


2 


3 


4 


6 


IO 


20 


30 


u 


Cerium, Oxalate of 


1 
4 


1 

3 


i 

2 


i 


ll 


2 


3i 


5 


grs. 


Chimaphila, Fl. Ext. of. - - - 


I 


2 


3 


4 


6 


IO 


20 


30 


drops. 


Chionanthus Virgin., Fl. Ext. of. 


I 


2 


3 


4 


6 


IO 


20 


30 


a 


Cimicifuga, Fl. Ext. of. - - - - 


3 
4 


I 


i§ 


3 


5 


6 


IO 


i5 


a 


Chloroform, Spirits of. - - - - - 


I 


2 


3 


4 


6 


IO 


20 


30 


a 


Chloral, Hydrate of 


1 


2 
3 


i 


2 


3 


4 


7 


10 


grs. 


Cinchonedia, Sulphate of. . 


1 
4 


1 
3 


i 

2 


I 


ii 


2 ' 


3l 


5 


a 


Cinnamon, Spirits of 


I 


2 


3 


6 


IO 


12 


20 


30 


drops. 


Cocaine, Hydro chlorate.' 


1 


1 
TI 


i 


i 

"5 


2 
"5 


2 
3 


ii 


2 


grs. 


Codine, Hydrochlorate. 


1 
TIT 


1 
-3TT 


i 

tit 


1 

TT 


1 


1 
3 


i 


1 


gr. 


Colchicum Seed, Fl. Ext. of. 


3 

1 6 


1 
T 


i 

4 


I 


3 
4 


I 


2 


3 


drops. 


Colinsonia Canadensis, Fl. Ext. of. . 






I 


2 


3 


4 


7 


10 


a 


Copaiba, Balsam of 


I 


ij 


-2 


3 


5 


8 


15 


20 


grs. 


m 
Corn Silks, Fl. Ext. of 


2 


4 


6 


12 


20 


24 


40 


60 


drops. 



TABLE OF DOSES— Continued. 



549 



NAMES 

OF 

MEDICINES. 


MONTHS. 


YEARS. 




d 

Go 


o 


00 

r-t- 
O 

H 

to 


M 

(-+■ 

O 

Go 


4^ 

O 


00 

c-t- 

o 

H 

to 


H 
bO 

O 

M 

ON 


H 
ON 

O 

to 

O 


THE 

AMT 


Crataegus Oxycantha, Fl. Ext. of 


1 
2 


I 


I 


2 


3 


4 


7 


IO 

30 


drops. 


Cotton Root, Fl. Ext. of. . . . 












12 


20 


n 


Damiana, Fl. Ext. of 










IO 


12 


20 


30 


a 


Digitalis, Fl. Ext. of 


1 
1 6 


l 
TI 


1 

TI 


1 
8 


i 

5 


1 


2 


I 


a 


Dioscorea Villosa, Fl. Ext. of. ... 


I 


2 


3 


6 


IO 


12 


20 


30 


it 


Dover's Powder 










3 


4 


7 


IO 


grs. 


Droseria Rotundifolia, Fl. Ext. of. 


i 


1 


i 


2 


3 


4 


7 


IO 


drops. 


Echinacea Angustifolia, Fl. Ext. of. . 


I 


2 


3 


6 


IO 


12 


20 


30 


a 


Elaterium 






1 
8 5 


i 

25 


1 
TIT 


1 
TI 


1 

TI 


g r - 


Ergot, Fl. Ext. of 


I 


2 


3 


6 


IO 


12 


20 


30 


drops. 


Erigeron, Oil of 


i 


2 
3 


i 


2 


3 


4 


7 


IO 
2 


a 


Gelsemium, Fl. Ext. of 


i 


2 
1 5 


i 

6 


1 
4 


2 


f 


ii 


a 


Gentian, Fl. Ext. of 


i 


2 


3 


6 


IO 


12 


20 


30 


it 


'Geranium, Powdered 




I 


i 


2 


3 


4 


7 


IO 

1 
"2TT 


grs. 


Gold and Soda, Chloride of. 


1 






i 

7 5 


1 

6 


1 
TIT I 


a 


Gossypium, Fl. Ext. of. ... 




3 


6 


IO 


12 


20 | 30 


drops. 


Grindelia Robusta, Fl. Ext. of. . . 


2 


4 


6 


12 


20 


24 


40 


60 


a 


Grindelia Squarrosa, Fl. Ext. of.. 


I 


2 


3 


6 


IO 


12 


20 


30 


a 


Hair-Cap Moss, Fl. Ext. of. . . 


I 


2 


3 


6 


IO 


12 


20 


30 


a 


Ffamamelis Virginica, Fl. Ext. of. . 


I 


2 


3 


6 


IO 


12 


20 


30 


a 


Hydrastis Canadensis, Fl. Ext. of. . 


3 
4 


I 


4 


3 


5 


6 


IO 


15 


a 


Hydrangea, Fl. Ext. of 


I 


2 


3 


6 


IO 


12 


20 


30 


a 


Hydrargyri, Chloridum Mite. . 


1 
4 


1 
2 


i 

2 


i 


i 


I 


I 


I 


g r - 


Hydrargyri, Chloridum Corrosivum. 






1 

2 8 8 


i 


i 

9 6 


1 

6 


1 
II 


1 

IT 


n 


1 2 




Hydrargyri, Iodum Rubrum. . 






1 

Til 


1 
II 


1 
IT 


1 

II 


1 

IT 


1 
TI 


a 


Hypophosphite of Lime and Soda, Syr. 


2 


4 


6 


12 


20 


24 


40 


60 


drops. 


Hypophosphites of Lime and Soda. . 


i 


\ 


i 


I 


2 


3 


6 


8 


grs. 


Iodine, Tr. of 


I 


2 
1 5 


i 


. 1 

3 


3 
5 


i 


*i 


2 


drops. 



550 THE PRACTICE OF MEDICINE. 








NAMES 

OF 

MEDICINES. 


MONTHS. 


YEARS. 




a 

a- 

fD 
Oo 


O 


oo 
o 

IH 

to 


H 

o 

Oo 


O 


00 

r-f- 

O 
H 

to 


M 

<— f 

o 

IH 

On 


HI 
ON 

r-t 
O 

to 




THE 

AM'T 


Iodoform 


1 
8 


2' 


1 

6 


1 

3 


3 


I 


I* 


2 


grs. 


Ipecac, Powdered 


1 


2 


* 


1 
3 


3 
"5" 


I 


li 


2 


a 


Iron, Muriated Tr. of 


I 


ii 


2 


3 


5 


7 


14 


20 


drops. 


Jaborandi, Fl. Ext. of 


I 


2 


3 


6 


IO 


12 


20 


30 


a 


Kino, Gum of. 


I 


il 


2 


3 


5 


7 


14 


20 


grs. 


Laudanum 










3 


5 


IO 


15 


drops. 


Lavender, Compound Spirits of. 


2 


4 


6 


12 


20 


24 


40 


60 


a 


Leptandrin - 


1 


t 


1 


1 
4 


2 
IT 


1 


I* 


2 


grs. 


Lime-Water 


1 
1 2 


* 


1 
T 


1 
4 


i 


i 

2 


! 


I 


oz. 


Lithium, Benzoate of 


1 
2 


1 


I 


2 


3 


4 


7 


IO 


grs. 


Lithium, Citrate of 


1 

2 


§ 


I 


2 


3 


4 


7 


IO 


a 




i 


1 

3 


i 


3 
4 


i 


2 


3 


4 


drops. 


Lupulin 


i 


1 


I 


2 


3 


4 


7 


IO 


grs. 


Magnesia, Carbonate of. . 


I 


2 


3 


6 


IO 


12 


20 


30 


n 


Mercury, Mild Chloride. . . . 


1 
4 


1 
2 


I 


i 


i 


I 


1 


1 


a 


Mercury, Bichloride of 






i 


i 


i 

¥1 


1 
6 


1 
1? 


1 

24 


a 


2 8 8 


1 20 




Mercury, Biniodide 


1 


1 


1 


1 


1 
6 4 


1 
IT 


1 


1 
TT 


u 


2 5 


20 


1 9 2 




Mint, Spirits of 


I 


ih 


2 


3 


5 


7 


14 


20 


drops. 


Monsel's Solution of Iron. 


1 
4 


i 


1 


i 


i-J 


2 


3* 


5 


a 


Morphine, Sulphate of 






1 

7 5 


i 


i 

2 4 


1 

T"2 


* 


i 


g r - 


Muriatic Acid. ...... 


1 
6 


1 
4 


1 
3 


2 
3 


I 


li 


2 


3 


drops. 




§ 


i* 


2 


4 


6 


8 


14 


20 


grs. 


Myrica Cerifera, Fl. Ext. of. 


1 


i* 


2 


4 


6 


8 


14 


20 


drops. 


Niter, Sweet Spirits of 


I 


2 


3 


6 


IO 


12 


20 


30 


a 


Nitrate of Silver. ...... 


1 

T~8 


1 
"5T 


1 

24 


i 

TTT 


i 

8 


1 
5 


4 


J 


grs. 




1 
4 


4 


1 

2 


! 


I 


2 


3 


4 


tt 


Nux Vomica, Fl. Ext. of. ... 


1 
4 


4 


J 


| 


I 


2 


3 


4 


drops. 


Oil, Castor 


I 


1 


I 


Fi 


2 


3 


3* 


4 


drms. 



TABLE OF DOSES— Continued. 



55i 



NAMES 

OF 

MEDICINES. 


MONTHS. 


YEARS. 




O 





00 

O 

H 


H 
O 





00 


H 

to 


M 
K) 

O 
H 

On 


H 

On 

O 

to 




THE 

AM'T 


Oil, Cod Liver 


1* 


i 


I 


III 


2 3 


32 


4 


drms. 


Oil, Erigeron Canadensis. . 


1 


§ 


I 


2 


3 4 


7 


IO 


drops. 


Opium, Gum 








1 

IT 


1 
1 2 


1 

3 


3 
4 


I 


g r - 


Paregoric 


2 


4 


5 


7 


12 


20 


40 


60 


drops. 




Pennyroyal, Oil of 












4 


7 


IO 


a 


Pepsin 


1 


§ 


1 


2 


3 


4 


7 


IO 






grs. 


Phytolacca Decandra, Fl. Ext. of. 


1 
4 


1 
3 


1 

2 


1 


1 


2 


3 


4 


drops. 


Pilocarpine, Hydrochlorate of. . 






1 


1 


1 

TI 


1 


2 


1 
3 


g r - 


Pinus Canadensis, Fl. Ext. of. 


I 


2 


3 


6 


IO 


12 


20 


3o 
30 


drops. 


Pipsissewa, Fl. Ext. of 


I 


2 


3 


6 


IO 


12 


20 


a 


Podophyllin 


1 


1 

1 £ 


1 

8 


1 
5 


1 
3 


I 


3 
4 


1 


g r - 


Polymnia Uvedalia, Fl. Ext. of. . 


1 
2 


I 


ii 


3 


5 


6 


IO 


15 


drops. 


Potash, Acetate of 


I 


*1 


2 


3 


5 


7 


14 


20 


grs. 


Potash, Bromide of 


I 


il 


2 


3 


5 


7 


14 


20 


u 


Potash, Iodide of 


1 


2 
3 


I 


ii 


2 2 


3* 


7 


IO 


(I 


Potash, Permanganate of. . . 


1 
4 


1 
3 


1 
2 


3 
4 


I 


2 


3 


4 


it 


Powder, Dover's 








1 
2 


2 


3 


7 


10 


il 


Prunus Virginiana, Syrup of. . . 


3 


4 


5 


7 


12 


20 


40 


60 


drops. 


Pulsatilla, Fl. Ext. of 


i 


J 


1 


ii 


2 


3 


3i 


4 


a 


Quinidine, Alkaloid 


I 


1 
2 


1 


2 


2I 


3* 


4 


5 


grs. 


Quinine, Sulphate of 


1 
3 


l 


1 


2 


2i 


3i 


4 


5 


a 




1 


2 


3 


6 


IO 


12 


20 


30 


drops. 


Salts, Epsom. 


1 
4 


1 
3 


1 

2 


3 
4 


I 


2 


3 


4 


drms. 


Sanguinaria Canadensis, Fl. Ext. of. 


* 


1 


i 


3 
4 


I 


2 


3 


4 


drops. 


Santonine 


i 


1 
3 


1 


3 
4 


I 


2 


3 


4 


grs. 


Soda, Phosphate of 


3 


4 


5 


7 


12 


20 


40 


60 


a 


Soda, Salicylate of 


i 


2 
3 


1 


2 


3 


4 


7 


10 


a 


Soda, Sulphite of 


1 


ii 


2 


3 


5 | 


7 


14 


20 


a 



552 



THE PRACTICE OF MEDICINE. 



NAMES 

OF 

MEDICINES. 


MONTHS. 


YEARS. 




Co 


c-f- 

o 


00 

o 

M 

to 


M 

o 

Co 


O 


oo 

r-h 

o 

M 

to 


M 

to 

r-t- 
O 
l-l 
ON 


M 

On 
c-t- 



to 

O 


THE 

AM'T 


Solution, Fowler's 


1 
6 


1 
4 


1 
3 


§ 


I 


4 


2 


3 


drops. 


Sparteine, Sulphate of 


1 

8 


1 
TT 


1 

T~8 


1 

28 


1 
TT 


i 


1 
6 


1 
4 


g r - 


Squill, Fl. Ext. of 


* 


1 
T 


1 
4 


1 


3 
T 


I 


2 


3 


drops . 


Squill, Syrup of 


3 


4 


6 


12 


20 


24 


40 


60 


a 


Stillingia, Compound Syrup of. 


3 


4 


6 


12 


20 


24 


40 


60 


11 


Sulphide of Calcium 


i 

1 


i 

9 


i 

TT 


1 
TT 


1 
"2T 


1 
TT 


1 
1 


I 


gr- 


Strychnine, Sulphate of. ... 






•1 

I"8T 


1 


1 


1 
TT 


1 

4 8 


1 

TT 


n 


16 


1 2 8 




Strychnine, Nitrate of 






1 
T8T 


1 


1 


1 

T6" 


1 

TT 


1 
TT 


a 


t 6 


12 8 




Tannic Acid 


i 


1 
3 


1 
2 


I 


ij 


2 


3h 


5 


grs. 


Turpentine, Spirits of 


1 

4 


i 


i 


I 


2 


2i 


3 


4 


drops. 


Tolu, Syrup of 


3 


4 


-6 


12 


20 


24 


40 


60 


a 


Veratrum Viride, Tr. of. . 


i 

TT 


i 

TT 


i 

8 


1 
5 


i 


i 


I 


1 


u 


Vitriol, Elixir of 


\ 


I 


li 


2 


4 


6 


IO 


16 


a 


Wild Cherry, Syrup of 


3 


4 


6 


12 


20 


24 


40 


60 


.<< 


Xanthoxylum, Fl. Ext. of. 


i 


2 


3 


6 


IO 


T2 


20 


30 


a 


Zinc, Oxide of 


i 


i 


i 

2 


I 


2 


2| 


3 


4 


grs. 


Zinc, Sulphocarbolate of. . 


i 


1 
T 


1 
4 


3 
T 


I 


l| 


2 


3 


a 



FORMULAS 553 

WHITE LINIMENT. 
Acetic Acid, 12 ounces, 

Spirits of Turpentine, 12 ounces, 

Eggs, thoroughly beaten, 2. 

Mix and shake the mixture briskly a few minutes. 
This is a valuable liniment and may be used in all cases 
where such applications are desired. It is a very efficient 
counter-irritant when applied by means of a cloth saturated 
with it. 

COMPOUND STILLINGIA LINIMENT. 

Oil of Stillingia, 1 ounce, 

Oil of Cajeput, . . \ ounce, 

Oil of Lobelia, 2 drachms, 

Alcohol, 2 ounces. 

Mix. This forms a peculiar form of liniment, possessing 
stimulant and relaxant properties. It is used in chronic 
asthma, croup, epilepsy, chorea, etc. In asthma and 
croup, the throat, chest and neck should be bathed with 
it three or four times a day. In chorea, epilepsy, etc., 
the whole spinal column should be bathed with it. In- 
rheumatism, sprains, etc., the diseased parts should be 
bathed with it. 

HAIR RESTORATIVE. 

Milk of Sulphur, 2 drachms, 

Sugar of Lead, 1 drachm, 

Glycerine, 2 drachms, 

Rose- Water, sufficient to make, 8 ounces. 

Mix and use as a hair dressing once or twice a day. 
It causes the hair to turn dark. 



554 THE PRACTICE OF MEDICINE. 

CANCER PASTE. 

The following is the prescription used by the majority 
of the so-called cancer doctors: 

Powd. Sanguinaria Canadensis, 1 drachm, 

Powd. Galangal Root, 3 drachms. 

Mix thoroughly and gradually add Chloride of Zinc 
until a thick paste is formed. Shape a piece of this paste, 
one-fourth of an inch thick, so that it will cover the sore 
and extend over the edges about the eighth of an inch, 
then, apply the paste retaining it in place with adhesive 
plaster. After the paste and adhesive strips are in place 
cover them with absorbent cotton, which should be retained 
in place with a • well fitting bandage. Let the paste 
remain on the sore for twenty-four hours, when, a fresh 
plaster should be applied and thus continued for three 
days, when, soft poultices should be applied until the 
slough separates, when, the sore may be treated as a simple 
ulcer. 



INDEX. 

Page 

Abortion, 474 

Absent Menstruation, 460 

Abscess, Perityphilitic, 283 

Acetanilide, 49 7 

Acetate of Potash 524 

Acid, Benzoic, 366 

" Carbolic, 527 

" Hydrochloric, 529 

" Tannic, 532 

" Boracic, 530 

Acites, .-. .......... . 211 

Aconite, 495 

Aconitum Napellus, , 495 

Acute Articular Rheumatism, 432 

" Albuminuria, 345 

" Bright's Disease, 345 

" Bronchitis, 134 

" Cystitis, 363 

"■ Inflammation of the Bladder, . .- . • 363 

" Gastritis, ;.'... 238 

" Inflammation of the Heart, 178 

Kidneys, 338 

Larynx, 1 20 

Stomach, 238 



(( U (i 



a a a a 



a a u a 



3 



556 INDEX. 

Page 

Acute Laryngitis, I2 o 

" Myocarditis, x 78 

" Nasal Catarrh, 10 ^ 

" Pharyngitis, 116 

" Peritonitis, 313 

" Sore Throat, 116 

After-pains, 485 

Ague Cake, 30, 332 

Albuminuria, Acute, 345 

Chronic, 349 

Alcohol, 502 

Amenorrhcea, 460 

American Hellebore, 494 

Ammonia, Bromide of 497 

Ammonii Chloridum, 541 

Amyl Nitrite, 500 

Anasarca, 213 

Anal Fissure, 296 

Aneurism, 196 

Angina Pectoris, 193 

Anthrax, 447 

Aphonia, 127 

Aphthae, 218 

Apocynum Cannabinum, 522 

Apoplexy, 399 

Apothecaries' Liquid Measure, 493 

Weight, 493 

Appendicitis, 283 



INDEX. 557 

Page 

Apparatus, The Urinary, . 335 

Argentum, 532 

Arbor Vitae, 518 

Arsenicum, 504 

Arsenic, 504 

Aromatic Spirits of Ammonia, 501 

Asclepias Syriaca, .- 523 

Asthma, 142 

Ataxia, Locomotor, 406 

Auri et Sodii Chloridum, 517 

Balanitis, 373 

Barosma Betulina, 521 

Balsam of Copaiba, 523 

Baptisia Tinctoria, 525 

Bayberry Bark, 534 

Bearsfoot, 543 

Belladonna, 498 

Bichloride of Mercury, 511 

Big Neck, 215 

Biliary Calculi, 324 

Bilious Fever, 34 

Biliousness, 318 

Biniodide of Mercury, 513 

Bismuthi Subnitras, 531 

Bites and Stings, Poisonous, 427 

Black Cohosh, 517 

Black Haw, 518 

Bladder, Acute Inflammation of, 363 



61 



u 



3$8 INDEX. 

Page 

Bladder, Chronic Inflammation of, 365 

" Stone in, 368 

Blood Poisoning, 201 

Blue Cohosh, 518 

Blue Stone, 533 

Mue Vitriol, 533 

Boils, l •. 446 

Boracic Acid, 530 

Bowels, After Delivery, 485 

Brain, Congestion of, 12 

Active,... 12 

Passive, 12 

Dropsy of, 206 

Breast, Infants', Care of, 487 

Break-bone Fever, 90 

Bright's Disease, Acute, 345 

" Chronic, 349 

Bronchial Catarrh, 134 

Bronchitis, Acute, 134 

" Chronic, 138 

Bromide of Ammonium, 497 

" " Calcium, 497 

" " Lithium, 497 

" " Potassium, 496 

Bromide of Sodium, 497 

"' "Zinc, .497 

Buchu, 521 

Burns and Scalds, 453 



INDEX. 559 

Page 

Cactus Grandiflorus, 498 

Cadmium, Sulphate of, .' 535 

Caecum, Inflammation of, 281 

Caffeine, Citrate of, 501 

Calcium, Sulphide of, 515 

Calculus, Vesical, 368 

Calculi, Renal, 358 

Calomel, 510 

Calx Sulphurata, 515 

Camphor, . . 501 

Camphorated Oil, . 527 

Cancer of the Stomach, 246 

" Paste, 554 

Canadian Hemp, 522 

Capsicum, 502 

Carbolic Acid, . . : 527 

Carbuncle, 447 

Carditis, Acute, 178 

Chronic, 179 

Care of the Infant, 486 

Catarrh, Acute Nasal, . . . , 107 

" Chronic " . 109 

Catarrhal Enteritis, 275 

Caulophyllum, 518 

Cephalalgia, 423 

Cerebral Hemorrhage, 399 

Chancroid, 392 

Change of Life, 465 



560 INDEX. 

Page 

Child Birth, 475 

Chimaphila, 522 

Chionanthus Virginica, 509 

Chills and Fever, 23 

Chills, Chronic, 27 

Chicken Pox, 84 

Chloral Hydrate, 539 

Chloride of Ammonia, 541 

" Gold and Soda, 517 

Chloroform, 542 

Chlorosis, 467 

Cholera, 270 

Infantum, 266 

" Morbus, 263 

Chorea, 410 

Chronic Albuminuria, 349 

" Articular Rheumatism, 435 

Bright's Disease, 349 

" Bronchitis, '. 138 

Constipation, 258 

Diarrhoea, 279 

" Enteritis, 279 

" Gastritis, 240 

" Inflammation of the Kidneys, . . . 349 

" Intermittent,. 27 

" Laryngitis, 1 23 

" Malaria, 27 

" Nasal Catarrh, 109 



INDEX. 561 

Page 

Chronic Nephritis, 341 

Peritonitis, 317 

Cimicifuga, 517 

Cinnamon, 519 

Cirrhosis of the Liver, 323 

Cistitis, Acute, 363 

Chronic, 365 

Citrate of Caffeine, 501 

Capp, 381 

Clavus, 45 1 

Cocainae Hydrochlorate, 542 

Cod Liver Oil, 506 

Codeine, 539 

Colic, 255 

" Hepatic, 324 

Lead, 257 

" Painter's, 257 

" Renal, 358 

Colica Pictonum, 257 

Colinsonia Canadensis, 508 

Compound Syrup of Stillingia, 514 

Stillingia Liniment, 553 

Congestion of the Brain, Active, 12 

" " " " Passive, 12 

Congestive Chill, 32 

Intermittent, 32 

Conjunctivitis, 456 

Consumption, 160 



562 i INDEX. 

Page 

Convulsions, Infantile, 420 

Corn, 451 

" Silk, 523 

Crataegus Oxycantha, 508 

Crisis, 7 

Croup, 128 

Membranous, 130 

Croupous Laryngitis, 130 

Cupri Sulph., 533 

Cuts, 455 

Damiana, 508 

Dance, St. Vitus', 410 

Dengue, 90 

Delivery, Treatment After, 484 

Diabetes, Insipitus, 354 

Mellitus, 355 

Diarrhoea, 259 

Digitalis, : 497 

Dilatation of the Heart, 187 

Diphtheria, 100 

Disease, Defined, 7 

" Contagious, 7 

" Functional, 7 

" Infectious, - - 7 

" Organic, * 7 

Periodic, - 17 

The Yellow, - 38 

Diseases of the Heart, Valvular, 182 



INDEX. 563 

Page 

Diseases of the Digestive Apparatus, 217 

" " " Nervous System, * 395 

" Pregnancy, 473 

" " the Respiratory Apparatus, 107 

" " Women, 459 

Dizziness, 4°8 

Dover's Powder, . 538 

Dropsy, 205 

of the Abdomen, 211 

" " Brain, 206 

" ". Chest, 210 

" " Heart, 208 

" " Scrotum, 212 

General, 213 

Drugs, Reliable, 494 

Dysmenorrhea, 463 

Dysentery, 285 

Dyspepsia, 250 

Intestinal, .... 253 

Dysuria, 370 

Ear-ache, 452 

Echinacea Angustifolia, 525 

Eczema, 442 

Emphysema, 171 

Endocarditis, 177 

Enlargement of the Heart, 185 

Enlarged Veins, 200 

Enlargement of the Spleen, 30, 332 



564 INDEX. 

Page 

Enteritis, Catarrhal, 275 

Chronic, 279 

Enuresis, 369 

Epilepsy, 412 

Epistaxis, 160 

Epsom Salts, 544 

Ergota, , 519 

Ergot, ; 519 

Eruptive Fevers, 67 

Erysipelas, 85 

Falling of the Womb, 472 

Famine Fever, 63 

Fatty Degeneration of the Heart, 189 

Feeding, Infant, 487 

Febricula, 42 

Felon, 449 

Fever, Bilious, 34 

Break-bone, 90 

General Treatment of, 22 

Intermittent, 23 

Irritative, - 42 

" Jail, 63 

" Lung, , 146 

" Milk, 485 

" Mountain, 67 

Remedies, 10 

" Remittent, 34 

Scarlet, 68 



INDEX. 565 

Page 

Fever, Ship, 63 

" Slow, . , 44 

" Spotted, 95 

" Swamp, 23 

" Typhoid, 44 

" Typhus, . . 63 

" Yellow, 57 

" Winter, 146 

Fevers, 21 

" Eruptive, 67 

Fistula In Ano, 299 

" of the Anus, -. , 299 

Fissured Nipples, 485 

Flexion of the Womb, -. . 472 

Flux, 285 

Follicular Stomatitis, 218 

Fox-glove, 497 

Fragrant Sumach, 521 

Fringe Tree, 509 

Furuncle, 446 

Gangrenous Inflammation of the Mouth, 222 

" Stomatitis, 222 

Gall-stones, 324 

Gastritis, Acute, 238 

Chronic, 240 

Subacute, 235 

Gastric Catarrh, 240 

"• Ulcer, 244 



566 INDEX. 

Page 

Gastric Carcinoma, 246 

Gastralgia, 254 

General Dropsy, 213 

Gelsemium, 495 

Gentian, 506 

Gin-drinkers' Liver, 323 

Gleet, .. 385 

Glonoin, 500 

Glossitis, r 225 

Goitre, 215 

Golden Seal, 505 

Gonorrhoea, 381 

Gossypium, 519 

Gout, 439 

Gravel, 358 

Green Sickness, 467 

Grindelia Robusta, 542 

Squarrosa, 543 

Haematuria, Malarial, 38 

Haematemesis, - - - 249 

Haemoptysis, 158 

Haemorrhoids, 293 

Hair-cap Moss, 521 

Hair Restorative, 553 

Hamamelis, - 53^ 

Hawthorn, - 5°^ 

Headache, 4 2 3 

Heart-burn in Pregnancy, 473 



INDEX. 567 

Page 

Heart, Dilatation of, 187 

Dropsy of, 208 

" Enlargement of, 185 

" Fatty Degeneration of, 189 

" Irritable, 192 

Neuralgia of, 193 

Palpitation of, 192 

Hellebore, American, 494 

Hematuria, 362 

Hemlock, Spruce, 536 

Hemorrhage, Cerebral, 399 

" of the Lungs, 158 

" " Nose, 160 

" " Stomach, 249 

" " Urinary Passages, 362 

Hepatic Colic, 324 

Hepatitis, 320 

Hernia, Femoral, 301 

Inguinal, 301 

Reducible, 300 

Strangulated, 300 

Umbilical, 301 

Herpes Zoster, 445 

Hops, 509 

Humulus Lupulus, 509 

Hydrangea, 522 

Hydrastis Canadensis, 505 

Hydrate of Chloral, 539 



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568 INDEX. 

Page 

Hydrargyrum, 509 

Hydrargyri Chloridum Mite, 510 

Corrosivum, 511 

Iodidum Rubrum, 513 

Subsulphas Flavius, 514 

Hypertrophy of the Spleen, 332 

" "- " Treatment of, 302 

Hyperemia, Renal, 336 

Hypodermic Syringe, 8 

Hysteria, 414 

Icterus, 327 

Ileus, .'. 305 

Impotence, 376 

Incised Wounds, 455 

Incontinence of Urine, 369 

Indigestion, 250 

" Intestinal, - . . 253 

Infant, Care of, 486 

Feeding, 487 

Infantile Convulsions, 420 

Inflammation of the Caecum, 281 

Bladder, Acute, 363 

Chronic, 365 

Brain, 395 

Breasts, 488 

Heart, Acute, 1 78 

" Chronic, 1 79 

Kidneys, Acute, 338 



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INDEX. 



569 



Page 

Inflammation of the Larynx, Acute, 120 

" Liver, Acute, 320 

" Mouth, 217 

" " Gangrenous, 222 

" " Ulcerative, 220 

" (Esophagus, 231 

" Pancreas, 333 

" Pelvis of the Kidneys, 343 

" Peritoneum, Acute, 313 

Chronic, 317 

" Pharynx, , 116 

" Rectum, 290 

" Small Intestines, 75 

" Spleen, Acute, 330 

Chronic, 30, 332 

" Stomach, Mild, 235 

" " Acute, 238 

Chronic, 240 

" Testicles, 374 

" Tongue, 225 

" Tonsils, 227 

" Vagina, 470 

" Veins, 198 

" Vulva, 471 

Influenza, 112 

Intestinal Colic, 255 

" Obstruction, 305 

Worms, 307 



570 INDEX. 

Page 

Iodide of Potash, 514 

Iodide, 516 

Iodoform, 529 

Ipecac, 541 

Ischuria, 370 

Irritable Heart, 192 

Irritative Fever, 42 

Irritation of the Stomach, 242 

Iron, Tr. of, 507 

Itch, 450 

Jaborandi, 524 

Jail Fever, 63 

Jaundice, 327 

Kidneys, Congestion of, 336 

Acute Inflammation of, 338 

Chronic " " 341 

King's Evil, 430 

Labor, 475 

" Management of, 479 

La Grippe, 112 

Laryngitis, Acute, 120 

Chronic, 123 

Croupous, 130 

Spasmodic, 128 

Large Round Worms, 309 

Laudanum, 53 8 

Lead Colic, 257 

Leucorrhcea, 468 



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INDEX. 571 

Page 

Liniment, Compound Stillingia, 553 

White, 553 

Lithii Citras, 524 

Lithium, Bromide of, 497 

Liver, Congestion of, 318 

Cirrhosis of, 323 

Gin-drinkers', 323 

" Inflammation of, 320 

Lobelia, 539 

Lock-jaw, 416 

Locomotor Ataxia, 406 

Looseness of the Bowels, 259 

Loss of Voice, 127 

Lysis, 7 

Magnesia Sulphate, 544 

Malarial Fever, 34 

Hematuria, 38 

Malaria, Pernicious, 32 

Management of Labor, 479 

Mastitis, 488 

Masturbation, 380 

Materia Medica, 489 

Measles, 74 

" German, 76 

Membranous Croup, 130 

Meningitis, . 395 

Epidemic Cerebro Spinal, 95 

Spinal, ^402 



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572 INDEX. 

Page 

Menorrhagia, 464 

Menopause, The, 465 

Menstruation, .- 459 

Absent, 460 

Painful, 463 

Profuse, 464 

Suppressed, 460 

Mercury, 509 

Metric System, 493 

Milk Fever, : 485 

Ministers' Sore Throat, 123 

Miscellaneous Diseases, 427 

Morning Sickness, 473 

Morphine Sulphate, 537 

Mountain Fever, 67 

Mountain Sickness, 67 

Muco-Enteritis, 275 

Mumps, 93 

Muriatic Acid, 529 

Muscular Rheumatism, 437 

Myocarditis, Acute, 178 

" Chronic, 1 79 

Myrica Cerifera, 534 

Naphthalin, 526 

Nephritis, Acute, S3^ 

" Chronic, 341 

Neuralgia, 4 22 

■" of the Heart, 193 



INDEX. 573 

Page 

Neuralgia of the Stomach, 254 

Nettle Rash, 441 

Nipples, Fissured, 485 

Nitrite of Amyl, 500 

Nitroglycerine, 500 

Nux Vomica, 505 

Oesophagitis, 231 

(Esophagus, Stricture of, 233 

Obstruction, Intestinal, 305 

Odontalgia, 424 

Oil, Castor, 544 

" Cod Liver, 506 

Oleum Ricini, 544 

Opium, 536 

Orchitis, 374 

Otalgia, : 452 

Otorrhcea, 453 

Oxide of Zinc, 535 

Oxyuris Vermicularis, 311 

Pain, 17 

Painful Menstruation, 463 

Painters' Colic, 257 

Palpitation of the Heart, 192 

Pancreas, The, 333 

Pancreatitis, ^^ 

Paralysis, 418 

Paraphimosis, 372 

Parasites, Intestinal, 307 



574 INDEX. 

Page 

Paregoric, 538 

Pasque Flower, 518 

Paste, Cancer, 554 

Part L, 7 

II., 21 

III., 107 

IV. - 173 

V., 217 

VI, 335 

VII., 395 

VIII,, 427 

IX -> - 459 

X., 489 

Parturition, ■ . .' 475 

Parotitis, 93 

Pathology, 7 

Pennyroyal, 519 

Pepper, Cayenne, 502 

Pericarditis, 173 

Periodic Diseases, ~ 17 

Perityphlitis, 283 

Perityphlitic Abscess, 283 

Peritonitis, Acute, 313 

" Chronic, 317 

Pertussis, - 133 

Pharyngitis, Acute, 116 

Chronic, 118 

Phimosis, 371 



INDEX. 575 

Page 

Phlebitis, 198 

Phosphorus, 506 

Phrenitis, 395 

Phthisic, 142 

Phthisis Pulmonalis, 160 

Phytolacca Decandra, - . . 516 

Piles, 293 

Pin-worms, 311 

Pilocarpus, 524 

Pinus Canadensis, 536 

Pipsissewa, , 522 

Pleurisy, 154 

Pleuritis, 154 

Pleuro-pneumonia, 148 

Pneumonia, 146 

Typhoid, 148 

Poisons and Antidotes, 544 

Poisonous Bites and Stings, 427 

Poisoning, Blood, 201 

Uraemic, 360 

Poke Root, 516 

Polymnia Uvedalia, 543 

Polytrichum, 521 

Potash, Acetate, 524 

Bromide of, 496 

" Iodide of, 514 

Pox, 386 

Pregnancy, Signs of, 472 



576 INDEX. 



Page 



£>' 



Pregnancy, Diseases of, 473 

Proctitis, 290 

Profuse Menstruation, 464 

Prolapsus, Ani, . . 298 

of the Womb, 472 

Protrusion of the Rectum, : 298 

Pruritus Vulvae, .' 471 

Pulsatilla, .,. 518 

Pulse, The, ,, 9 

Pulvis Ipecacuanhae et Opii, 538 

Pyelitis, ..;. 343 

Quicksilver, . , . . 509 

Quinidine, 503 

Quinine Sulphate, 503 

Quinine, 503 

Quinsy, 227 

Recapitulation, 18 

Reliable Drugs, 494 

Rectum, Protrusion of, 298 

Renal Colic, 358 

Retention of Urine, 370 

Rheumatism, 432 

Acute Articular, 432 

Chronic " 435 

Muscular, 437 

Rhus Aromatica, - 521 

Ring-worm, 444 

Rotheln, 76 



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INDEX. 577 

Page 

Rubeola, 74 

Running from Ears, 453 

Rupture, 300 

Reducible, . . 300 

Strangulated, 300 

Inguinal, 301 

Femoral, 301 

Umbilical, - 301 

Salol, 526 

Salts, 544 

Salt Rheum, 442 

Scabies, 450 

Scalds, 453 

Scarlatina, 68 

Scarlet Fever, 68 

Scrofula, 430 

Scrotum, Dropsy of, 212 

Self Abuse, 380 

" Pollution, 380 

Septicaemia, 201 

Shingles, 445 

Ship Fever, 63 

Sickness, Morning, 47-3 

" Mountain, 67 

Signs of Pregnancy, 472 

Silk-weed, 523 

Silver, 532 

Slow Fever, 44 



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578 INDEX. 

Page 

Small-Pox, 77 

Sodium, Bromide of, 497 

Soft Chancre, 392 

Sore Eyes, 456 

" Throat, Acute, , . 1 16 

Chronic, 118 

Ministers', 123 

Spasmodic Laryngitis, 128 

Spasms, Infantile, : ; 420 

Sparteine Sulphate, ,...". 500 

Spermatorrhoea, 378 

Spirits of Ammonia, Aromatic, 501 

" Chloroform, 542 

" Turpentine, 528 

Splenitis, Acute, 330 

Spleen, Enlargement of, — 30, 332 

Spinal Irritation, 404 

Meningitis, 402 

Spotted Fever, 95 

St. Anthony's Fire, 85 

St. Vitus' Dance, 416 

Stigmata Maydis, 523 

Stillingia, Compound Syrup of, 514 

Stings, Poisonous, 427 

Stomach, Cancer of, 246 

Hemorrhage From, 249 

Neuralgia of, 254 

Ulceration of, 244 



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INDEX. 579 

Page 

Stomatitis, 217 

Gangrenous, 222 

" Ulcerative, 220 

Stone in the Bladder, 368 

" Root, 508 

Strangury, 370 

Stricture of the (Esophagus, 233 

" " Urethra, 1 373 

Strychnine, 499 

Subacute Gastritis, 235 

Subnitrate of Bismuth, 531 

Sugar of Lead, 531 

Sulphate of Cadmium, 535 

" Calcium, 515 

" Morphine, 537 

" Quinine, 503 

" Sparteine, 500 

" zinc > 535 

Sulphide of Calcium, .' 515 

Sulphite of Soda, 526 

Sulphocarbolate of Zinc, 531 

Sun-stroke, , 408 

Suppressed Menstruation, 460 

Syphilis, 386 

Syrup of Wild Cherry, 541 

Table of Doses, 547 

Taenia, , 307 

Tannic Acid, 532 



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580 INDEX. 

Page 

Tape-worm, 307 

Temperature, Normal, 9 

Terebinthina, 528 

Testicles, Inflammation of, 374 

Tetanus, 416 

Tetter, 442 

The Bowels, 16 

Hypodermic Syringe, 8 

Menopause, 465 

" Metric System, 493 

" Pulse, 9 

" Tongue, 15 

" Urinary Apparatus, 33$ 

" Yellow Disease, 38 

" Dose of Medicine, 547 

Thermometer, 9 

Thread-worms, 311 

Thrush, 218 

Thuja Occidentalis, 518 

Tincture Muriate of Iron, 507 

of Opium, 538 

Opii Camphorata, 538 

Tinea Circinata, 444 

Tonics, 18 

Tonsillitis, 227 

Tongue, - 15 

Inflammation of, 225 

Toothache, 424 



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INDEX. 581 

Page 

Toothache, in Pregnancy, 473 

Treatment after Delivery, 484 

Trichina Spiralis, 312 

True Croup, 130 

Tuberculosis, 160 

Turpeth Mineral, 514 

Typhilitis, 281 

Typhus Fever, 63 

Ulcer, Gastric, 244 

Ulcerative Stomatitis, 220 

Inflammation of the Mouth, 22a 

Ulceration of the Stomach, 244 

Uraemia, 360 

Uraemic Poisoning, 369 

Urine, Incontinence of, 36a 

Retention of, 370 

Urethra, Stricture of, 373 

Urticaria, 441 

Vaccination, 8^ 

Vagina, Inflammation of, 470 

Vaginitis, 470 

Valvular Diseases of the Heart, 182 

Varicocele, 375 

Varicosed Veins, 200 

Varicella, 84 

Variola, 77 

Veins, Inflammation of, 198 

Varicosed, 20a 



582 INDEX, 

Page 

Veratrum Viride, 494 

Verruca, 451 

Version of the Womb, 472 

Vertigo, 408 

Vesical Calculus, 368 

Virburnum Prunifolium, 518 

Voice, Loss of, 127 

Vomiting, 242 

in Pregnancy, 473 

Vulva, Itching of, 471 

" Inflammation of, 471 

Vulvitis, 471 

Warts, «. 451 

Whitlow, .- 449 

Weight, Apothecaries', .-. 493 

Weights and Measures, 493 

Whites, 468 

Whiskey, 502 

White Liniment, 553 

Whooping Cough, 133 

Wild Indigo, 525 

Winter Fever, 146 

Witch-hazel, , 536 

Worms, Intestinal, - 307 

Worm, Tape, 307 

Pin, 3 1 1 

Thread, 3 11 

Wounds, Incised, - 455 



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INDEX. 583 

Page 

Yellow Fever, 57 

Jack, 57 

Jasmine, 495 

Young's Rule in Determining the Dose, 547 

Zinc, Bromide of, 497 

" Sulphate of, 535 

" Sulphocarbolate, . ." 531 

" Oxide, 535 



The Practice of Medicine 

Price $3.50 



Agents Wanted 



Address the Publishers, or 

A. M. Nicks, M. D., 
Biggers, Ark. 



APR 3 



1907 



